QuestionSBA
QuestionChoice
A bacterial infection causing reactive neutrophilia is the second most likely diagnosis and should be excluded. His observations being within normal limits (e.g. him being afebrile) and being otherwise well suggests infection is less likely. He has likely received prednisolone for his RA flare, resulting in neutrophilia.
10034844
c
Infection
QuestionChoice
This is unlikely given the clinical history. Leukaemias such as CML may result in a leukocytosis/neutrophilia, but there are no other cell lines affected, nor is there a compatible clinical history.
10034843
b
Leukaemia
QuestionChoice
Methotrexate can cause bone marrow suppression and pancytopenia, rather than neutrophilia. It is more likely that this patient has received a course of prednisolone for his RA flare.
10034845
d
Methotrexate use
QuestionChoice
Neutrophilia can be caused by infections (particularly bacterial), medications (steroids and lithium predominantly), inflammation, stress, and malignancies. In this case, the patient has likely received steroids for their flare of rheumatoid arthritis, resulting in neutrophilia.
10034842
a
Prednisolone
QuestionChoice
NSAIDs are not known to cause neutrophilia. It is more likely that this patient has received a course of prednisolone for his RA flare, causing neutrophilia.
10034846
e
NSAID use
QuestionComment
What is causing the iron deficiency anaemia?

45106
QuestionComment
i assumed it was anaemia of chronic disease from RA
59842
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Htu2256
Concept
Chapter
2693
6092
Neutrophilia
Topic
157
Haematology
19372
Prednisolone can cause neutrophilia, often seen in patients with inflammatory conditions like rheumatoid arthritis.
A patient is called by his GP with concerns about his blood test results. He has had routine investigations as he has been feeling very fatigued recently. He has a background of rheumatoid arthritis which he has just experienced a severe flare of.


On examination, he looks well and observations are within normal limits.


Blood test results:

||||
|--------------|:-------:|---------------|
|Haemoglobin|121 g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|23.2x10<sup>9</sup>/L|3.0 - 10.0|
|Mean Cell Volume (MCV)|77.1 fL|80 - 96|
|Neutrophils|17.8x10<sup>9</sup>/L|2.0 - 7.5|
|Lymphocytes|2.9x10<sup>9</sup>/L|1.5 - 4.0|
|Eosinophils|0.1x10<sup>9</sup>/L|0 - 0.4|
|Basophils|0.1x10<sup>9</sup>/L|0 - 0.1|
|C Reactive Protein|15.2 mg/L|< 5|

What is the most likely explanation for this abnormality?
a