Case 131 – update 1

The patient reports a 2 week history of exertional dyspnoea, fevers and weight loss. Examination does not demonstrate any lymphadenopathy or hepatosplenomegaly. Other than a few bruises on his arms and pallor due to anaemia, there are no other remarkable findings. Observations are normal except for a low grade temperature of 37.7 – there are no focal signs of infection.

The patient is known to be HIV positive and has been on HAART for several years now – his last HIV viral load from a month ago was undetectable and his CD4 count was normal (510). He has no other significant past medical history and no transfusion history.

His U/Es, LFTs and coagulation are within the normal range, but his reticulocyte count is low. Haematinics, TFTs and LDH are pending. He does not drink alcohol. His only regular medications are his HAART (emtricitabine, tenofovir and efavirenz).

The biomedical scientists have already prepared an urgent blood film (see below) and the sample has been sent for flow cytometry with results expected later this evening.


How would you report this blood film?

Given the clinical history and blood film findings, what is your differential diagnosis?


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