QuestionSBA
QuestionChoice
This would explain the patient's thrombocytopenia (low platelets), and may also explain the splenomegaly. However, the symptoms would be purpura of the legs and increased bleeding. There would also be no effect on the WCC, and so increased infection rates would not be expected, and the RBC count would also remain within normal ranges.
10000550
e
Immune thrombocytopenic purpura
QuestionChoice
Asthma would not lead to any of these symptoms, and we would not expect any changes on a FBC.
10000548
c
Asthma
QuestionChoice
Anaemia of chronic disease is a good differential as it can cause a normocytic anaemia. However, the raised WCC and presenting symptoms are more suggestive of an underlying malignancy.
10000549
d
Anaemia of chronic disease
QuestionChoice
Whilst this fits with the 'repeated chest infections' part of the patient history, it would be unlikely for pneumonia to cause symptoms such as splenomegaly and night sweats - although a general fever may be present. A two-month history is also a chronic presentation for something such as an infection. The WCC is also very high for an infection, and instead suggests a haematological cancer.
10000547
b
Community-acquired pneumonia
QuestionChoice
The patient's history gives red flag symptoms of cancer, such as unintentional weight loss and night sweats. Splenomegaly is a key sign of chronic lymphocytic leukaemia, and is caused by the production of malignant cells within the spleen. Enlarged lymph nodes also occur due to the proliferation of malignant cells. The repeated chest infections are due to the malignant lymphocytes being unable to fight off infection. The blood results show raised WCC due to the malignancy, low platelets (thrombocytopenia) and anaemia due to lack of space in the bone marrow for red blood cell development. The patient is also within the key age-range for this leukaemia.
10000546
a
Chronic lymphoid leukaemia
Concept
Chapter
2693
3786
Leukaemia
Topic
157
Haematology
12656
A 60-year-old man with no significant past medical history presents with a two-month history of weight loss, night sweats, fatigue and repeated chest infections. On examination, he has enlarged cervical lymph nodes and palpable splenomegaly. The results from his initial full blood count are shown below. Which of the following differential diagnoses is most likely at this stage?
 

|                |         |                   |
| -------------- | :-------: | --------------- |
| Haemoglobin    |        104 g/L   | (M) 130 - 170, (F) 115 - 155 |
| Mean Cell Volume (MCV)                   | 90 fL                  | 80 - 96       |
| White Cell Count   |     67.3x10<sup>9</sup>/L   | 3.0 - 10.0      |
| Platelets          |     120x10<sup>9</sup>/L            | 150 - 400     |
| Red blood cells |  3.53 x 10<sup>9</sup>/L                 | 4.50 - 6.50      |
| Haematocrit | 31.9%                  | 40 - 54       |
a