Question

‏Fatima is a 36-year-old female with a megaloblastic anemia. An initial diagnosis of moderate anemia, jaundice, and neurological complications was made. Based on the patient’s laboratory test results, she was diagnosed as having a vitamin B12 deficiency. Her CBC results showed MCV of 87 fl. The Schilling test demonstrated that the deficiency was due to the absence of intrinsic factor. This patient can be diagnosed with a megaloblastic anemia due to a lack of intrinsic factor. The patient is suffering from the adult form of pernicious anemia with demonstrated anti-intrinsic factor antibodies. Still, the doctor was not definite of the final diagnosis. In order to help understanding the case:

‏What is the morphologic classification of the patient’s anemia?

‏What abnormal morphological findings on a stained blood smear comprise the triad in megaloblastic anemia?

‏What further testing can be done to obtain a definitive diagnosis?

‏What would you predict this patient’s reticulocyte count to be?

‏What you expect other CBC indices of WBC and platelets?

Answer 1

The morphological classification of anemia- according to the data given above - MCV -87fl - so it is normocytic anemia .
As MCV < 82fl ( microcytic )

MCV = 82-98fl( normocytic)

MCV - > 98fl ( macrocyclic)

Abnormal morphological blood smear findings- a) macro- ovalocytes b) red blood cells with Howell - jolly bodies .
c) hypersegmented neutrophils

Tests for defective diagnosis - a) methylmalonic acid measurement .

b) bone marrow biopsy- shows megaloblastic hyperplasia

Patients reticulocyte count may be decreased due to fragile and abnormal erythroid precursor.