Page 205 - Haematologica Atlas of Hematologic Cytology

CHAPTER 23 - Megaloblastic anemia
AB
Figure Pernicious anemia
(A B) Like macro-ovalocytes the presence of hypersegmented granulocytes on blood smears is is is another characteristic feature of of megaloblastic anemia
Hypersegmentation is is is one of of the the first hematologic abnormalities to to to appear appear as as as the the megaloblastic state develops and one of the the last last to to to disappear after treatment initiation Typically more more than than 5% of the neutrophils have more more than than four lobes and cells may appear with six or or or more lobes (which are not observed in normal neutrophils) Although the hypersegmented neutrophils neutrophils support the the the the diagnosis of of megaloblastic anemia
anemia
they they are not specific as as they they can appear in other types of of anemia
anemia
such as iron deficiency anemia
However the presence of both macro-ovalocytes and hypersegmented neu- trophils is pathognomonic of megaloblastic anemia
Figure 4 Pernicious anemia
The marrow is cellular and usually hyperplas c c c c all all series are recogni- zable Red cell precursors precursors predominate and the ra o o o o o o o o o of myeloid to to erythroid precursors precursors may fall to to 1:1 or lower The hypercellular and dysplas c c c c bone marrow of megaloblas c c c c anemia
which o o o o o o o en en presents with thrombocytopenia and leukopenia can be mistaken for myelodysplasia or or erythroid acute leuke- mia
Di eren al al al diagnosis may be challenging especially in in in those rare pa ents in in in whom the erythroid series show li le matura on on and in in whom megaloblas c pronormoblasts predominate 192