Fiji School of Medicine

1
Megaloblastic Anemia
COW Case of the Week

• Fiji School of Medicine
• CWM Hospital.

2
Presenting symptom

• 70year Indian Female
• Presented with Congestive cardiac failure
• Hb 4gm, MCV 136 fl
• ? B12 deficiency
• Not a vegetarian, gastroscopy normal
• Blood smear and Bone marrow.

3
Blood Film
Small lymphocyte Macrocytic RBC
4
Blood Film
Small lymphocyte Macrocytic RBC Thrombocytopenia
5
Blood Film
Small lymphocyte Macrocytic RBC (oval)
6
Bone Marrow
Giant Metamyelocyte
7
Bone Marrow
Mitotic figures (metaphase)
8
Bone Marrow
Giant Metamyelocyte
9
Bone Marrow
Megaloblasts
10
Bone Marrow
Cytoplasmic Asynchrony (immature nucleus, mature
cytoplasm)
11
Bone Marrow
Megaloblast
12
Bone Marrow
Giant Metamyelocyte
13
Bone Marrow
Giant Metamyelocyte