Case 124 – The beginning

You are helping out in new patient haematology clinic. You have just had your post-lunch coffee and are raring to go! The next patient has been referred via the 2ww pathway by their GP for investigation of an abnormal FBC, with concern about an underlying malignancy. They are a 68 year old lady with a PMH of:

  • Hypertension
  • CKD stage 2
  • Mild asthma (PRN salbutamol only)
  • Total hip replacement 2012
  • Provoked DVT secondary to this in 2012 (completed 3 months of anticoagulation with warfarin)

Her FBC from the GP is as follows (normal range in brackets):

Haemoglobin               87 g/L (115 – 165)

White cell count          5.2 x 109/L (4 – 11)

Platelets                        538 x 109/L (150 – 450)

Mean Cell Volume      108 fl (80 – 100)

Haematocrit                0.45 (0.37 – 0.47)

Neutrophils                 3.6 x 109/L (2 – 7.5)

Lymphocytes               1.9 x 109/L (1.5 – 4.5)

How would you approach the clinical assessment of this patient? What further investigations would you organise?


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