Case 148: the beginning

You are the liaison haematology registrar and receive a call from the gastroenterology team for advice about a 24 year old male patient under their care. He is a previously fit and well university student who initially presented 3 months ago with jaundice due to an unexplained acute hepatitis, which is now resolving. Extensive investigations have excluded any viral, toxic, metabolic, structural or autoimmune aetiology. His LFTs are nearly back to normal now and he is well in himself, but they have noticed that his blood counts are dropping with each clinic appointment (previously normal).

His FBC from today is as follows:
Hb                      93  (130-180)
Platelets             83  (150-450)
WCC                 2.2 (4-11)
Neut                   0.9 (2-7)
Lymphocytes     0.8 (1-4.5)
Monocytes         0.3 (0.2-0.8)

What further investigations would you advise?
What is your differential diagnosis?

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