Case series 138 – Part 1

You are the surgical SHO on call and get called by A+E to see a 23 year old patient with severe abdominal pain. The patient is septic and being treated with broad spectrum antibiotics and fluid resuscitation. Examination demonstrates severe abdominal tenderness with guarding, rebound tenderness and generalised abdominal rigidity. An urgent CT scan is performed which confirms perforated appendicitis.

As you prepare to get the patient to theatre, the haematology laboratory calls with abnormal blood results.

Full blood count
Hb 108               (130-180)
MCV 92            (80-100)
Platelets 670     (150-450)
WCC 75           (4.0-11.0)
Lymph 4.4      (0.5-3.5)
Neut 70          (2.0-8.0)
Eosin 0.1         (0.1-0.5)
Baso 0.1          (0.0-0.1)
Mono 3.4        (0.2-1.2)

The BMS has made an urgent blood film:

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