Table 2 Investigations (2006)
Blood tests

  • Hb 116 g/l (130–180), MCV 101 fl (80–100), white cell count 2.2×109/l (4.0–11.0) (neutrophils 0.74, lymphocytes 1.01, monocytes 0.42, eosinophils 0.01), platelets 428×109

  • Blood film: anisopoikilocytosis, burr cells, acanthocytes, neutropaenia

  • Normal urea, electrolytes, glucose, liver function, blood clotting; erythrocyte sedimentation rate 14 mm/h, C reactive protein 11 mg/l

  • Serum IgG 8.06 g/l (5–15), IgA 2.53 g/l (0.8–4.5), IgM 0.98 g/l (0.35–2.9)

  • Serum protein electrophoresis–no paraproteinaemia. No Bence Jones protein in urine

  • Negative: ANA, ANCA, ENA, anti Hu/Yo/Ri, anti-GM1, anti-GQ1B

  • Serum ACE 64 (6–63 u/l)

  • Anti-endomysial antibody negative, anti-tissue transglutaminase IgA 0.7 (0.1–7.9 AU)

  • Blood vitamin A 0.4 μmol/l (1.0–3.0), vitamin E <3 μmol/l (15–45), vitamin B12 >1000 ng/l, folate >20.0 μg/l

Bone marrow aspirate: mildly hypercellular
Cerebrospinal fluid

  • No cells

  • Protein 0.43 g/l

  • Glucose 3.2 mmol/l (serum 3.8 mmol/l)

  • No oligoclonal bands

  • Negative PCR for HSV1, HSV2 and VZV DNA

  • Cytology unremarkable

  • ACE, angiotensin converting enzyme; ANA, antinuclear antibodies; ANCA, antineutrophil cytoplasmic antibodies; ENA, extractable nuclear antigen antibodies; Hb, haemoglobin; HSV, herpes simplex virus; MCV, mean corpuscular volume; VZV, varicella zoster virus.