Case 1 – update 2

Thanks for all your comments on the blood film – you mentioned  hypersegmented neutrophils, tear drop cells as well as a macrocytic anaemia, possible ovalocytes and some rouleaux. 

You add a B12 and folate level as well as immunoglobulins onto the bloods.

You peruse the hospital records system to try to find out more about the patient. Previous letters suggest alcohol excess and previous pancreatitis.

The folate level comes back at <2ug/L and vitamin B12 is 112 pmol/L.  By the time these are back you find that the patient is already completing his third unit of blood on the admissions suite. Do  you have any further advice for the admission suite?

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