1st August 2023

A 31 year old man from Brazil is admitted to AMU. He was previously fit and well and recently arrived in the UK

A 31 year old man from Brazil is admitted to AMU. He was previously fit and well and recently arrived in the UK to visit extended family after completing a charity expedition in the Amazon rainforest. He reports a 3 day history of high fever, malaise, joint aches, and gum bleeding after brushing his teeth. He thinks his skin has a yellow appearance.

On examination, he is pyrexial, tachycardic, jaundiced, and with evidence of minor epistaxis. His blood pressure is 94/58 mmHg with a capillary refill time of 4 seconds. Chest and heart sounds are normal, but there is tenderness in the right upper quadrant of the abdomen. A rapid diagnostic test for malaria is negative.
Which of the following investigation findings is most likely to be seen?

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