Diagnosishaematological features

• Atypical lymphocytes on blood film (recognised by the dark blue cytoplasmic edge to cells and invagination (scalloping) around red blood cells).

• Usually lymphocytosis with mild neutropenia.

• Occasionally anaemia due to cold antibody mediated haemolysis (anti-i)—identify with cold haemagglutinin titre.

• Paul Bunnell/monospot test for presence of heterophile antibody +ve when cause is EBV but only in the first few weeks. False +ves can occur in lymphoma.

• 4 bilirubin and abnormal LFTs.

• Serological testing should include EBV capsid Ag, CMV IgM, Toxoplasma titre, Brucella titre, HIV 1 and 2 Ag and Ab.

• Immunophenotype of peripheral blood B lymphocytes shows poly-clonality (distinguishes from lymphoma and other lymphoproliferative disorders).

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