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Case 257 - Discussion

Uploaded: 2012-02-08, Updated: 2012-02-08


The patient was found to have low serum vitamin B-12 level.


Megaloblastic Anemia

  • The bone marrow biopsy in the patient show hypercellular marrow with marked erythroid hyperplasia and left shifted granulopoiesis. The marrow smears show erythroid precursors with megaloblastic changes with large regular nuclei and fine chromatin. Occasional hypersegmented neutrophils and giant bands are noted.

  • Megaloblastic changes should be distinguished from megaloblastoid changes, which is usually seen in myelodysplastic syndrome. Megaloblastoid changes typically show coarse and clumped chromatin with more obvious dysplastic cytological features.