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28th May 2025
A 77-year-old female presents to her GP with fatigue and easy bruising.
A 77-year-old female presents to her GP with fatigue and easy bruising. She has a history of breast cancer and received a combination of chemotherapy, surgery, and radiotherapy 4 years ago. She had a mammogram 3 months ago which showed no signs of recurrence. She is a non-smoker and does not drink alcohol.
Examination reveals pallor and mild petechiae in the lower limbs but is otherwise unremarkable. Her GP arranges for bloods.
| Hb | 72 g/L | (130-180 g/L) | B12 | 310 pg/ml | (180-1000 pg/ml) |
| WCC | 1.2 x 10⁹/L | (3.6-11 x 10⁹/L) | Folate | 9.4 ng/ml | (>4 ng/ml) |
| Platelets | 24 x 10⁹/L | (150-400 x 10⁹/L) | Ferritin | 240 ng/ml | (10-300 ng/ml) |
| Neutrophils | 0.6 x 10⁹/L | (1.8-7.5 x 10⁹/L) | MCV | 106 | (80-100 fL) |
| TSH | 3.4 mU/L2 | (0.4-4.0 mU/L2) | |||
| Blood film comment – dysplastic neutrophils present, no RBC fragments | |||||
Which investigation is likely to reveal the diagnosis?
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