26th July 2024

A 69-year-old lady presents to her GP with symptoms of fatigue

A 69-year-old lady presents to her GP with symptoms of fatigue and pain in her right arm and left thigh, which she describes as a deep, boring pain. On examination she is found to be pale and have conjunctival pallor. Blood tests reveal:

Hb 89 g/L (115-165)

Serum urea 11 mmol/L (3.0-6.5)

Serum creatinine 140 µmol/L (60-125)

Corrected calcium 2.6 mmol/L (2.15-2.55)

Serum albumin 27 g/L (32-50)

Serum total protein 82 g/L (63-80)

A blood film is performed:

What abnormality can be seen?

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