🔬 Clinical case: severe anemia with macrocytosis in a 70-year-old male. Diagnosis: pending. 🩸 Laboratory data: HGB – 59 g/L (severe anemia) RBC – 1.33 × 10¹²/L MCV – 121.5 fL (marked macrocytosis) PLT – 90 × 10⁹/L (thrombocytopenia)
Blood morphology: ✅ Erythrocyte macrocytosis ✅ Neutrophil hypersegmentation ✅ Occasional large platelets 🙏Publication kindly provided by laboratory assistant Vadim Jankulov, Kazakhstan, Ust-Kamenogorsk.
REFERENCE INFORMATION Preliminary conclusions. Marked macrocytic anemia, thrombocytopenia, and changes in blood smear may indicate:
- Vitamin B₁₂ or folic acid deficiency (most likely)
- Myelodysplastic syndrome (MDS)
- Other causes of macrocytosis (hypothyroidism, medication use, alcoholism)
Recommendations:
- Determination of vitamin B₁₂, folic acid, homocysteine, and methylmalonic acid levels.
- Thyroid function assessment (TSH, free T₄).
- Exclusion of myelodysplasia (cytogenetic study, bone marrow biopsy if necessary).
- Urgent correction of anemia (if B₁₂ deficiency is confirmed – parenteral administration of cyanocobalamin).
