Severe Megaloblastic Anemia: Cellular Morphology

A clinical case of severe megaloblastic anemia, featuring bone marrow morphology with megaloblasts, neutrophil hypersegmentation, and blood parameters.

Anna Feditskaya 1 min January 11, 2025

Bone marrow smear: multinucleated megaloblast and myeloid cells

Bone marrow smear: binucleated megaloblast and giant myelocytes

Bone marrow smear: polychromatophilic and orthochromatic megaloblasts

Bone marrow smear: karyorrhexis of an erythroblast and atypical forms

Bone marrow smear: megaloblastic hyperplasia of the erythroid lineage

Bone marrow smear: predominance of megaloblasts at different maturation stages

Peripheral blood smear: hypersegmented neutrophil and ovalocytes

Hematology analyzer screen: RBC, PLT histograms and scattergrams

Hematology analyzer screen: CBC parameters after transfusion, HGB 41 g/L

🩸 Severe Megaloblastic Anemia in a 48-year-old Patient

🔬 Peripheral Blood Analysis: UPON ADMISSION: Hemoglobin (Hb): 19 g/L Red Blood Cells (RBC): 0.43 × 10^{12/L
White Blood Cells (WBC): 2.5 × 10}9/L AFTER BLOOD TRANSFUSION: ❗ CBC after blood transfusion is shown in the image.

🦴 MYELOGRAM The bone marrow shows a pronounced predominance of megaloblastic hematopoiesis, characteristic of this type of anemia. Key morphological changes: ✅ Megaloblasts constitute up to 70% of cells. Bi- and trinucleated forms are found. ✅ Karyorrhexis (nuclear fragmentation) is observed in erythroblasts. ✅ Giant myelocytes and band neutrophils are present. ✅ Hypersegmented neutrophils are characteristic. 📋 Conclusions The morphological findings from the bone marrow and peripheral blood confirm the diagnosis of megaloblastic anemia, likely caused by vitamin B12 or folic acid deficiency.

💡 To clarify the diagnosis, it is recommended to: 📊 Determine blood levels of vitamin B12 and folate. 🧪 Perform a test for intrinsic factor antibodies. 📎 Assess the state of the gastrointestinal tract (e.g., gastroscopy) to rule out malabsorption of vitamins.

🙏 Clinical case kindly provided by biologist Anna Feditskaya, Luhansk.