Case 126 – Update 1!


We advised the GP to repeat the asymptomatic 57 year old patient FBC (with film) in 4-6 weeks and to refer to haematology if absolute lymphocyte count was >10 or if he had associated cytopenias / B symptoms / lymphadenopathy / hepatosplenomegaly.

Unfortunately after 4 weeks the GP contacts you again to say the patient re-presented with drenching night sweats. On examination he has an macular rash over his thorax and the spleen is now palpable 3cm below the costal margin.

Repeat FBC: Hb 125 Plts 110 WCC 62 Neuts 4 Lymphocytes 56

Blood film:




  1. What does the blood film show? Diagnosis??
  2. What further investigations would you request?


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