Macrocytic anaemias

1-Megaloblastic anaemia-(Folate & B12

deficiency ,chemotherapy effect, myelodysplasia, or primary
morrow disorders).
2-Nonmegaloblastic -(alcoholism, liver disease, haemolysis,
hypothyrodism)

Megaloblastic anaemia - is the result of nuclear maturation

defect with anaemia attributed to ineffective erythropoiesis
with abnormal appearing erythroid precursors(Megaloblast).
 Causes of Megaloblastic anaemia
• 95% of megaloblastic anaemia are caused by either
cobalamin B12 or folic acid deficiency.
• Vitamins Which are necessary as coenzymes for nucleic acid
synthesis.
• Inherited disorders affecting DNA synthesis are rare causes of
megaloblastosis.
 Lab. finding
•1- CBC
•Haemoglobin and red cells count ranging from normal to
very low.
•PCV: normal may be high
•MCV is increased more than 100 fl.
• MCH is increased because of large size of cells.
• MCHC is normal.
•WBCs: moderate leukopenia
•Plts: moderate thrombocytopenia (can lead to hemorrahge )
• pancytopenia.
2- Blood film:
RBCs: shows anisopoikilocytosis,Oval
macrocytosis(macro-Ovalocytes), microcytes and
fragmented cells, polychromasia, tear drop cells and
Howell-Jolly bodies in NRBCs or mature cells. In
sever cases may see megaloblast. Dimorphic picture
if associated with IDA
WBCs: Hypersegmented neutrophils(over 5% are 5
lobed), myelocyte may be seen
•Nucleated RBCs indicate the attempted of the
bone marrow to increase the RBCs mass.
3- Bone marrow
•It the confirmatory test and shows.
•Hypercellular with an increase in the
erythroid precursors.
•Howell-Jolly bodies.
•Giant metamyelocytes.
•Megaloblastic maturation with arrested
maturation (a synchronism)
• half the erythroid precursors show
megaloblastic change.
 Megaloblast

Are large nucleated erythroid precursors

with nuclear maturation lagging behind
cytoplasmic maturation(nucleus stains
poorly).
promegaloblsts
Howell-Jolly bodies

Oval macrocyte
Hypersegmentation
 Folate deficiency
• It is present in foods.(eggs, milk, yeast, liver,
green leafy vegetables).
• It is also synthesized by microorganism.
• The vitamin is destroyed by heat.
• Absorption takes place in the proximal
jejunum.
 4-Lab. Analysis of folate
Two methods are used.
• Microbiological method(uses bacteria whose
growth and replication require folic acid
(lactobacillus casei).
Reference range 3 to 25 ng/mL.
• Radioimmunoassay method.
Reference range 2 to 10 ng/mL.
• Normal erythrocyte folate is 140 to 960 ng/mL.
 Cobalamin deficiency
•Cobalamin is necessary for synthesis of
methionine the central reaction in DNA
synthesis.
•It is present in most food of animal origin.
•Dialy need 3 to 5 µg
•Cobalamin store 5 g.
 5-Lab. Analysis of B12

Two methods.
1- Microbiological method (Lactobacillus
leishmannii- Euglena gracilis).
2- Radioimmunoassay.