This week, we are looking at a sample from a 34-year-old female who presented to her GP after experiencing months of progressive fatigue that she initially chalked up to a busy work schedule. However, a recent craving for chewing on large quantities of ice prompted her to seek medical advice.

The patient notes that her fatigue has become so pronounced that climbing a single flight of stairs leaves her short of breath. On physical examination, the GP noted distinct pallor of the conjunctiva and skin, along with slight brittleness in her fingernails.

Key Laboratory Results:

• RBC: 3.95 x 10¹²/L
• Hb: 84 g/L
• MCV: 64.2 fL
• MCH: 19.5 pg
• RDW: 19.8%

The analyser flagged the red cells for review and so a film was made:

Based on the clinical presentation and the blood film above, what do you think it could be? Follow the case on LinkedIn here.