This week we have a case from a 61-year-old patient who presented with persistent fatigue and unintentional weight loss. Routine bloods were performed, and the full blood count has raised some important red flags.

Full blood count results:

• WBC: 50.4 × 10⁹/L
• RBC: 2.96 × 10¹²/L
• Hb: 84 g/L
• HCT: 0.245
• MCV: 91.5 fL
• MCH: 28.4 pg
• MCHC: 339 g/L
• RDW: 15.2%
• Platelets: 122 × 10⁹/L

The analyser also generated abnormal scattergram flags and a blast flag, prompting a manual differential and film review.

The sample was sent for flow cytometry. Here is a summary of the immunophenotype results:

There’s quite a lot going on here. What stands out to you at first glance? Drop your initial thoughts below.

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