Case series 138 – part 3

You are a GP registrar working in primary care. It’s 5 pm on Friday and you are going through the last few blood results before the weekend. The final patient is a normally fit and well 69 year old man who had bloods done as part of an NHS Health Check.

Full blood count
Hb 128             (130-180)
MCV 92            (80-100)
Platelets 138   (150-450)
WCC 220          (4.0-11.0)
Lymph 212      (0.5-3.5)
Neut 6.0          (2.0-8.0)
Eosin 0.4         (0.1-0.5)
Baso 0.1          (0.0-0.1)
Mono 1.5         (0.2-1.2)

The last FBC from his last Health Check 5 years ago was completely normal.

You call the patient at home and he tells you that he feels “champion”.

The BMS has made a blood film.

Questions

1) What is the differential diagnosis here?

2) How would you report the blood film?

3) Does the patient need to be admitted to hospital? If so, why? If not, how urgently should they be seen by haematology?

4) Is this patient at risk of leukostasis (i.e. symptomatic hyperviscosity due to high WCC)?

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