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: 228 × 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?