1st April 2022

A 59-year-old Caucasian male has come to see his general practitioner (GP) with the results of his recent blood tests

A 59-year-old Caucasian male has come to see his general practitioner (GP) with the results of his recent blood tests. He had presented to the GP with fatigue and abdominal fullness that had been present for many months. He has a past medical history of gout and hypertension. On examination splenomegaly had been detected. His blood results are below.

Full Blood Count:

• Haemoglobin: 101 g/L [Reference Range: 135-175 g/L (male)]
• WBC (White Blood Cells): 3.1 x 10^9/L [Reference Range: 4.0-11.0 x 10^9/L]
• Platelets: 96 x 10^9/L [Reference Range: 150-450 x 10^9/L]
• MCV (Mean Corpuscular Volume): 78 fL [Reference Range: 80-96 fL]
• RBC (Red Blood Cells): 4.5 x 10^12/L [Reference Range: 4.5-6.5 x 10^12/L (male)]

Urea and Electrolytes:

• Urea: 7.3 mmol/L [Reference Range: 2.5-6.7 mmol/L]
• Sodium: 132 mmol/L [Reference Range: 135-145 mmol/L]
• Potassium: 4.1 mmol/L [Reference Range: 3.5-5.0 mmol/L]
• Creatinine: 100 mmol/L [Reference Range: 62-106 mmol/L (male)]

Liver Function Tests:

• Total Protein: 65 g/L [Reference Range: 64-83 g/L]
• Albumin: 34 g/L [Reference Range: 35-50 g/L]
• Alanine Aminotransferase (ALT): 45 U/L [Reference Range: 7-56 U/L]
• Alkaline Phosphatase (ALP): 225 U/L [Reference Range: 40-130 U/L]
• Total Bilirubin: 25 umol/L [Reference Range: 2-24 umol/L]

Thyroid Function Test:

• Thyroid Stimulating Hormone (TSH): 2.1 uIU/mL [Reference Range: 0.4-4.0 uIU/mL]
• Free Thyroxine (T4): 1.2 ng/dL [Reference Range: 0.7-1.9 ng/dL]
• Free Triiodothyronine (T3): 5.4 ng/dL [Reference Range: 2.3-4.2 ng/dL]

Which of the following is the most likely cause?

Select the SINGLE most appropriate option from the list below. Select ONE option only.