Anemias-continuation
Blood Picture in Megaloblastic anaemia
Film: Normochromic, Anisocytosis
poikilocytosis, macrocytosis, tear
drop cells
• Variable degree of
anemia, may reach a low
of 2-3g/dl.
• MCV increased >100 fl,
maybe up to 135.
• Low retics.
• Leucocytes maybe
reduced, some
neutophils maybe
hypersegmented.
• Platelets maybe
reduced.
Blood Film in Megaloblastic anemia
Hypersegmented Neutrophils
Normoblastic & Megaloblastic Erythropoiesis
Megaloblastic
Normoblastic
• 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.
• 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).
IDA-blood film
Hypochromic microcytic red cells, with some
pencil cells and teardrop cells
Blood film in Thalassaemia major
Nucleated red cell
Hypochromic , aniso-cytosis, poikilocytosis, target cells
Blood Film in thalassemia
Thals. Major
Normal blood film
Thalassemia minor
In β-thalassemia major: sever hypochromic anemia, prominent target cells,
spherocytic cells and N.RBCs./ β-thalassemia minor : mild hypochromic
anemia , some targets, and teardrop cells.
Hb H preparation
Golf ball appearance
( precipitated HbH in
RBCs) New
methylene blue stain
Spherocytosis
Discrimination by age of onset and Combs Test
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.
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.
Positive Sickling test