MRCP2-2257

MRCP2-2257

A 55-year-old man presented to his GP with complaints of feeling lethargic and unwell. Despite having a normal appetite, he had lost two stones in weight over the past six weeks. He also reported excessive sweating at night, causing his wife to frequently change the sheets. Additionally, he experienced upper abdominal discomfort.

During examination, the patient appeared thin and unwell. His pulse was 90 beats per minute in sinus rhythm with blood pressure of 145/80 mmHg. A short systolic murmur was audible at the lower left sternal edge. His chest was clear, and his abdomen was soft with slight tenderness in the epigastrium and central abdomen. The spleen was palpable 7 cm below the left costal margin.

Further investigations revealed a haemoglobin level of 97 g/L (130-180), a white cell count of 17.4 ×109/L (4-11), and a platelet count of 550 ×109/L (150-400). The blood film showed left-shifted neutrophils with numerous myelocytes present, occasional promyelocytes, and no blasts. There were also a number of nucleated red blood cells as well as a large number of tear drop red cells.

Given these findings, what should be the next investigation performed?