Anemias-continuation

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Anemias-continuation
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Blood Picture in Megaloblastic anaemia

• Variable degree of anemia, may reach a low of
  2-3g/dl.
• MCV increased gt100 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
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Blood Film in Megaloblastic anemia
Hypersegmented Neutrophils
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Normoblastic Megaloblastic Erythropoiesis
Megaloblastic
Normoblastic
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• 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.

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• 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).

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IDA-blood film
Hypochromic microcytic red cells, with some
pencil cells and teardrop cells
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Blood film in ?Thalassaemia major
Nucleated red cell
Hypochromic , aniso-cytosis, poikilocytosis,
target cells
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Blood Film in thalassemia
Thals. Major
Normal blood film
Thalassemia minor
In ß-thalassemia major sever hypochromic anemia,
prominent target cells, spherocytic cells and
N.RBCs./ ß-thalassemia minor mild hypochromic
anemia , some targets, and teardrop cells.
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Hb H preparation
Golf ball appearance ( precipitated HbH in RBCs)
New methylene blue stain
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Spherocytosis
Discrimination by age of onset and Combs Test
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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.

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Sickle Cells

• 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.

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Positive Sickling test