BOF 13

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BOF: 13

A 75-year-old woman presents with a six-week history of malaise and weakness. There is hepatosplenomegaly and a pleural effusion

Investigations:

Hb 10.8 g/dL

WCC 44 x 109/L

94% lymphocytes

2% neutrophils

2% eosinophils

Plts 93x109/L

ESR >120 mm/hr

A pleural tap shows the following results:

Protein 48g/L

Glucose 1.8 mmol/L

Microscopy: Lymphocytes +++. No bacteria on Gram Stain, no AAFB seen

What is your next investigation?

a)      Silver stain of pleural fluid

b)      Serial blood cultures

c)      Sputum culture and microscopy

d)      Bone marrow biopsy

e)      Abdo ultrasound

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