Haematology
Case 13: A Patient with Increasing Breathlessness
CASE
A 24‐year‐old student is referred to haematology with a 3‐month history of increasing breathlessness on exertion. He is also finding it increasingly difficult to concentrate on his studies due to lethargy. On examination he was pale but not jaundiced. He had a normal cardiovascular, respiratory and abdominal examination.
Blood tests showed:
Hb 7.4 g/dL MCV 95 fL WBC 2.6 × 109/L Platelets 78 × 109/L Blood film Unremarkable Urea 3.5 mmol/L Creatinine 94 µmol/L Bilirubin 12 µmol/L ALT 25 U/L ALP 168 U/L Corrected Ca 2.35 mmol/L
Previous blood tests one year ago were normal. A bone marrow aspirate was performed which showed a marked reduction in blood forming cells and no malignant infiltrate.
QUESTION 1
Your score this session: 0 of 0
What is the most likely diagnosis?
After appropriate treatment, the patient did very well and regained normal blood counts. Five years after the initial diagnosis, he presented to A&E with abdominal pain and bloody diarrhoea. A mesenteric vein thrombosis was diagnosed and he was commenced on anticoagulation.
Blood results at presentation showed: