Case 80 – the beginning

Welcome to our new case. You are the surgical house officer reviewing a new elective admission. He is 65 years old gentleman and has been admitted for resection of a gastric cancer. He is an ex-smoker, takes ramipril for hypertension and simvastatin for hypercholesterolaemia and has slight elevated fasting glucose. He drinks moderate amounts of alcohol (20-25 units per week). A preoperative full blood count reveals:

  • Hb 105g/l (130-180)
  • MCV 97fl (82-98)
  • WCC 3.5×10*9/l (4-11)
  • Neutrophils 0.9×10*9/l (1.7-7.5)
  • Lymphocytes 2.0×10*9/l (1.5-4.5)
  • Platelets 110×10*9/l (150-450)

 

He was at preoperative assessment clinic two weeks earlier and the results were similar there but no additional work up was performed. The surgeon is worried about infection and asks whether GCSF should be administered as the surgery is urgent.

 

Questions

  • What are the differential diagnosis of the FBC findings?
  • What may you look for on examination?
  • Would you give GCSF?

 

Please reply to us (@TeamHaem) on Twitter and always include #TeamHaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #TeamHaem on Twitter for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion and learning.

 

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Online education and discussion about all things haematological
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