April 20, 2009

White Blood cell in peripheral blood film

The photomicrograph shown below was obtained from peripheral blood

1) What abnormality shown in the blood film (2m)

2) In what condition do the above finding presents and name one complication for each findings (8m)

[Question is taken and modified from Question 194, page 215; Pre Test USMLE step 1 Pathology 10th edition, Earl J. Brown M.D, The McGraw-Hill Companies, 2002]



- Neutrophilic hypersegmentation (6 lobe neutrophil)

- Target cell


a) B-12 Deficiency

- Megaloblastic anaemia

- Sub acute combined degeneration of spinal cord

b) Folate deficiency

- Open neural tube defect in fetus


In contrast to a normal, mature neutrophil, which has from two to five nuclear lobes, the neutrophil shown has at least six lobes and is an illustration of neutrophilic hypersegmentation.

Granulocytic hypersegmentation is significant and among the first hematologic findings in the peripheral blood of patients who have megaloblastic anemia in its developmental stages.

Neutrophilic hypersegmentation is generally considered a sensitive indicator of megaloblastic anemia, which can be caused by a deficiency in vitamin B12, in folate, or in both. Tetrahydrofolate (FH4) acts as an intermediate in the transfer of one-carbon units from compounds such as formiminoglutamic acid (FIGlu), a breakdown product of histidine. Excess urinary levels of FIGlu are a useful clinical indicator of a folate deficiency

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