Thanks for everyones contributions so far. Further information now available as requested by yourselves:
Patient decline over past 6 months – 0.5 stone weight loss, no night sweats / fevers. Marked lethargy and generally feeling ‘achey’. Poor appetite but no early saiety and previously unremarkable diet. Constipated. No bleeding / bruising. No symptoms suggestive of autoimmune disease. No medications.
Positive findings on examination:
- Pale. Spleen palpable 2cm below the costal margin.
- Hb 95, MCV 103, Plts 90, WCC 17, Neuts 14, basophils 0.04
- Mild AKI ( Ur 12, Cr 105). CRP 10.
- Ferritin 35, B12 / folate NAD
- HIV and hepatitis screen negative. Serum electrophoresis in progress.
- What is your current differential diagnosis?
- What further investigations would you now perform?
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.