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 BOF 88

 

   

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BOF: 88

A 66 year old male presents with a history of fever and cough of a few days duration. He had previously been reasonably well although he had been complaining of feeling tired and weak for several weeks prior to admission. He was a diet controlled diabetic and was not on any other treatment. He smoked 10 cigarettes a day and had done so for the last 40 years.

He was a retired banker married and had 3 children. He lived with his wife and had been managing independently until admission.

On examination he looked unwell, was febrile, had a pulse rate of 110 beats per minute, BP 110/80. There was evidence of a left basal consolidation. On examination of his abdomen he was noted to have a moderately enlarged spleen.

Investigations

Hb 8.5 g/dL

WBC 55.7 x 109/L

Neutrophils 40 %

Metamyelocytes 10 %

Myelocytes 21%

Myelocytes 4%

Blast cells 20 %

Nucleated red cells 5%

Platelets 34 x 109/L

In this patient which one of the following investigations would you arrange in order to reach the underlying diagnosis?

a)      Bronchoscopy

b)      CT scan of chest

c)      Bone marrow examination

d)     Leucocyte alkaline phosphatase score

e)      Blood cultures

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