It's not often the first day of the month aligns with a Monday and you know what that means! It's time for a new case.

This week's case comes from a 46 year old male who presented to his GP with a few weeks of:

Increasing tiredness
Mild shortness of breath on exertion
Occasional light-headedness

He has no significant past medical history, does not take regular medications, and reports no recent infections. He drinks alcohol socially but not excessively. On examination:

Mild pallor noted
No jaundice
No hepatosplenomegaly
Vitals within normal limits

His GP requested routine blood tests, which showed some notable abnormalities and prompted the laboratory to review the blood film.

FBC Results showed:

Haemoglobin: 104 g/L
RBC: 3.5 × 10¹²/L
HCT: 0.32
MCV: 91 fL
MCH: 29.7 pg
MCHC: 326 g/L
RDW: 14.2%
WBC: 6.7 × 10⁹/L
Platelets: 480 × 10⁹/L

A blood film was prepared for morphology review:

What is the highlighted cell you can see in the image? What conditions do you associate with it?