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