Chronic Liver Disease: The presence of acanthocytes (abnormal red blood cells with spiky projections) is strongly associated with liver disease, particularly advanced liver disease. The mild anemia (Hb 120 g/L) and slightly low white blood cell count could also be seen in the context of liver dysfunction affecting blood cell production or survival.

Myeloproliferative Neoplasm (e.g., Myelofibrosis): Although less directly linked to acanthocytes, myeloproliferative neoplasms can cause abnormalities in blood cell counts, including anemia and changes in the red blood cell indices. The presence of acanthocytes might be less common but could be seen in the context of bone marrow fibrosis affecting red blood cell morphology.
Chronic Kidney Disease: Anemia is common in chronic kidney disease due to decreased erythropoietin production. While acanthocytes are not typically associated with kidney disease, the overall clinical picture, including the patient's age and potential for multi-system disease, makes this a consideration.

Hemolytic Anemia: Although the absolute reticulocyte count is not provided, hemolytic anemias can present with anemia, and some forms (like hereditary spherocytosis or autoimmune hemolytic anemia) might have abnormal red blood cell morphology. Acanthocytes can be seen in some hemolytic conditions, and missing a diagnosis of hemolytic anemia could lead to significant morbidity if not treated.
Lymphoma or Leukemia: These conditions can cause pancytopenia or abnormalities in blood cell counts. While acanthocytes are not a hallmark, the combination of a low white blood cell count and anemia warrants consideration of a bone marrow disorder, including lymphoma or leukemia, which would require prompt diagnosis and treatment.

Abetalipoproteinemia: This is a rare genetic disorder characterized by the absence of apolipoprotein B-containing lipoproteins, leading to severe deficiencies of fat-soluble vitamins. Acanthocytes are a hallmark of this condition, but given its rarity and the patient's age, it is less likely unless there is a specific clinical history suggestive of this diagnosis.
Neuroacanthocytosis Syndromes: These are a group of rare genetic disorders characterized by the presence of acanthocytes and neurological abnormalities. They are less likely given the lack of mentioned neurological symptoms but should be considered if there are unexplained neurological findings.