You are the critical care registrar on call and get called to A+E to review a 65 year old patient in resus.

The patient is in extremis with sats of 88% on 15 L non-rebreath mask and is septic with haemodynamic instability. His wife is present and says that he’s normally fit and well but has gradually deteriorated over the last 3 weeks with a sudden deterioration in the last 48 hours. He tested negative for COVID-19 three days ago.

A portable chest x-ray is arranged.

As you are about to organise transfer to intensive care, the haematology laboratory calls with abnormal blood results.

Full blood count
Hb 78               (130-180)
MCV 92            (80-100)
Platelets 46     (150-450)
WCC 390           (4.0-11.0)
Manual differential in progress.

An urgent blood film is made by the BMS.