Anemias-continuation

Blood Picture in Megaloblastic anaemia

• Variable degree of anemia, may reach a low of 2-3g/dl.

• MCV increased >100 fl, maybe up to 135.

• Low retics.• Leucocytes maybe

reduced, some neutophils maybe hypersegmented.

• Platelets maybe reduced.Film: Normochromic,

Anisocytosis poikilocytosis, macrocytosis, tear drop cells

Hypersegmented Neutrophils

Blood Film in Megaloblastic anemia

Normoblastic & Megaloblastic Erythropoiesis

Normoblastic

Megaloblastic

• The CBC here shows a markedly increased MCV, typical for megaloblastic anemia. The MCV can be mildly increased in persons recovering from blood loss or hemolytic anemia, because the newly released RBC's, the reticulocytes, are increased in size over normal RBC's, which decrease in size slightly with aging.

• The RBC's here are smaller than normal and have an increased zone of central pallor. This is indicative of a hypochromic (less hemoglobin in each RBC) microcytic (smaller size of each RBC) anemia. There is also increased anisocytosis (variation in size) and poikilocytosis (variation in shape).

IDA-blood film

Hypochromic microcytic red cells, with some pencil cells and teardrop cells

Blood film in Thalassaemia major

Nucleated red cell

Hypochromic , aniso-cytosis, poikilocytosis, target cells

Blood Film in thalassemia

Thalassemia minor

Normal blood film

Thals. Major

In β-thalassemia major: sever hypochromic anemia, prominent target cells, spherocytic cells and N.RBCs./ β-thalassemia minor : mild hypochromic anemia , some targets, and teardrop cells.

Hb H preparation

Golf ball appearance ( precipitated HbH in RBCs) New methylene blue stain

Spherocytosis

Discrimination by age of onset and Combs Test

G6PD enzyme deficiency

• The blood film shows irregularly contracted cells [deep red arrows]

and sometimes blister cells [deep blue arrow] in which all the

haemoglobin appears to have retracted to one side of the erythrocyte.

• Variable anemia (6-8g/dl), normochromic in SCA, hypochromic in Sickle /thal syndromes.

• Sickle cells and target cells, with polychromasia and sometimes NRC on film.

• Retics increased 10-20% usually.

Sickle Cells

Positive Sickling test