Chart-2

A 45 year old female presented with easy fatiguability and paraesthesia.

On Examination: Pallor, mild jaundice, glossitis and red beefy tongue noted.

Laboratory findings

Histogram

PERIPHERAL BLOOD SMEAR    

BONE MARROW SMEAR 

A. Interpret the histogram, peripheral blood smear and bone marrow. 

• Hb- 9.6 gm/dl ↓ 

• RBC- 2.69 mil/cumm ↓ 

• PCV- 28.8 % ↓ 

• MCV- 117.6 fl ↑ 

• MCH- 39.6 pg ↑ 

• MCHC- 33.7 gm- N 

• RDW- 16.1 % ↑ 

• TLC- 2,100/cumm ↓ 

• N- 71.1%; L- 15.9%; E-5.5%; M-3.3%;B-0.3%= normal 

• Platelet- 78,000/cumm ↓ 

Histogram 

• Shift to right due to macrocytosis 

• Broad base due to anisocytosis 

• Short broad peak due to low RBC count 

Peripheral blood smear 

• RBC s: reduced in number, macrocytic normochromic, macroovalocytes seen. 

• WBC s reduced in number, hypersegmented neutrophils seen. 

• Platelets reduced in number 

Macrocytic Anemia 

Bone marrow aspiration 

• Hypercellular 

• M:E ratio- 1:4 

• Erythroid hyperplasia with megaloblastic maturation 

• Myeloid series of cells are reduced in number, with giant metamyelocytes and band forms 

• Megakaryocytes- are reduced in number 

B. What is the diagnosis? 

Megaloblastic Anemia 

C. Describe the characteristic appearance of the cell. 

Large sized erythroblasts with nucleocytoplasmic asynchrony and sieve like chromatin. Nuclear maturation lags behind cytoplasmic maturation. 

D. Mention two biochemical tests for the diagnosis of the same. 

• Serum Cobalamin assay - decreased (N:180-914 ng/L) 

• Serum Folate assay - decreased (N:2-20 ng/ml) 

• Serum LDH- increased (N: in adults-100- 190 U/L) 

• Schilling test- to distinguish intrinsic factor deficiency and malabsorption which result in B12 deficiency