Page 204 - Haematologica Atlas of Hematologic Cytology

Figure 1 Megaloblas c c c c c anemia
due to cobalamin de ciency The presence in in blood smears of ma- crocy c c c c c c c c erythrocytes with an an oval shape is is one of of the characteris c c c c c c c c features of of megaloblas c c c c c c c c anemias Nearly 50% of red cells are are are oval oval and many are are are larger than normal Macro-ovalocytes are are are well lled with hemoglobin and the central pallor is is is o o o o o o o o o en en en reduced or or absent Macro-ovalocytes dis nguish megalobla- s s s s s s c c c c c c c c c anemias from other condi ons with red cell macrocytosis For example macrocytes that characterize accelerated erythropoiesis and liver disease are usually round Erythrocyte anisopoikilocytosis is is is is is not li- mited to large ovalocytes but may include as as in in this case the presence of spherocytes and dacryocytes AB
Figure Megaloblas c c c c c anemia
due to folate de ciency (A) This blood smear clearly shows the remarkable red cell anisopoikilocytosis that may be observed in megaloblas c c c c anemia
Besides large oval red cells here we recognize fragmented and and bizarrely-shaped small erythrocytes When anemia
is is severe poikilocytosis and and fragmenta on of erythrocytes may be severe severe enough to suggest a a a a a a a a microangiopathic disorder (B) Par cularly in cases of severe severe ane- mia
a a a a a a a wide variety of red red cell cell inclusions as as well as as nucleated red red cells may be observed In this eld you recognize a a a a a a a a a Howell-Jolly body in in in in a a a a a a a a a large large round erythrocyte (le ) ) and a a a a a a a a a thin Cabot ring in in in in a a a a a a a a a large large oval red cell (right) 191