26th August 2020

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
  • Hb 101 g/L
  • WCC 3.1 x109L
  • Platelets 96 x109L
  • MCV 78 fL
  • RBC 4.5 x1012L
• Urea and electrolytes
  • Urea 7.3 mmol/L
  • Sodium 132 mmol/L
  • Potassium 4.1 mmol/L
  • Creatinine 100 mmol/L
• Liver function tests
  • Total protein 65 g/L
  • Albumin 34 g/L
  • Alanine aminotransferase 45 U/L
  • Alkaline phosphatase 225 U/L
  • Total bilirubin 25 umol/L
• Thyroid function test
  • Thyroid stimulating hormone (TSH) 2.1 uIU/mL
  • Free thyroxine (T4) 1.2 ng/dL
  • Free triiodothyronine (T3) 5.4 ng/dL

Normal values:

• Hb:
  • Men: 130 – 180 g/​L
  • Women: 115 – 165 g/​L
• WCC:
  • Total: 3.6 – 11.0 x 10⁹/L
  • Neutrophils: 1.8 – 7.5 x 10⁹/L
  • Lymphocytes: 1.0 – 4.0 x 10⁹/L
  • Monocytes: 0.2 – 0.8 x 10⁹/L
  • Eosinophils: 0.1 – 0.4 x 10⁹/L
  • Basophils: 0.02 – 0.10 x 10⁹/L
• Platelets: 140 – 400 x10⁹/L
• RCC:
  • Men: 4.5 – 6.5 x 10¹²/L
  • Women: 3.8 – 5.8 x 10¹²​​/L
• MCV: 80 – 100 fL

Which of the following is the most likely cause?

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