We are investigating a 68 year old lady referred with a macrocytic anaemia and thrombocytosis. Thanks for all of your helpful input thus far. Tests you have requested to date:
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)
Folate/B12 – normal
LFTs – normal
Ferritin – normal (with a normal CRP)
Retics – borderline low
Haemolysis screen (LDH, DAT) – negative
Coag screen – negative
CT chest, abdomen, pelvis – no evidence of malignancy. No size significant lymphadenopathy and normal liver/spleen. Confirms previous right total hip replacement.
Blood film is prepared and shown below (the BMS comments that there is a lot of platelet clumping and platelet islands, and confirms a thrombocytosis):
What does the blood film demonstrate? What would be the next step in your investigation of this lady?
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