This week’s case comes from a patient of Southeast Asian descent who was recently admitted for a routine surgical workup. Interestingly, despite having no significant symptoms of anaemia, their laboratory results caught the attention of the haematology team.

Clinical context

The patient is originally from a malaria-endemic region. While they are clinically well and have a normal haemoglobin level, the automated analyser flagged several morphological warnings when processing the FBC.

Based on the blood film image and the clinical context provided:

• What abnormality are we seeing?
• What is the specific genetic mutation that causes this?
• What is the evolutionary advantage of this morphological trait?

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