Case 143: update 1

This man has no known past medical history and takes no regular medications. He is usually fit and
well and works as a chef. He smokes 10 cigarettes per day and drinks alcohol within recommended
limits. He lives in Newcastle, UK.

Examination is unremarkable (no hepatosplenomegaly). His treating team are concerned he is having a myocardial infarction. He undergoes successful coronary stenting and is discharged from hospital the following day on dual antiplatelets, a statin, an ACE-inhibitor and a beta-blocker.

His GP is asked to repeat his FBC the following week, which shows the following:

Hb 189 g/L
Hct 58%
MCV 85 fL
Plt 611 x109/L
WCC 16.3 x109/L

Neut 8.43 x109/L

Lymph 4.26 x109/L
Mono 3.51 x109/L
Baso 0.10 x109/L
Eosino 0.00 x109/L

Given his background and recent events, what would you advise at this point? Do you think this is a primary or secondary problem?

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