There are a number of conditions in which hypersegmented neutrophils may be seen, such as megaloblastic anemias (including folic acid deficiency and. BMJ Case Rep. Aug 17; pii: bcr doi: /bcr Hypersegmented neutrophils and oval macrocytes in the setting of. Hypersegmented neutrophils and reversible hyperpigmentation in vitamin B12 deficiency in Ghana. Ivy Adwowa Efiefi Ekem.

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The third patient presented with haemolytic anaemia with depression, and was managed as such initially. At the time her Hb was 9. In all three cases, hypersegmentdd family member had had such an ailment. This is a clinical laboratory finding.

Vitamin B 12 deficiency is the primary cause of megaloblastic anaemia in Zimbabwe. Persisting vague neurological symptoms lead to a check of serum vitamin B 12which was found to be low.

She was pale, had hyperpigmented soles and palms as well as abdominal tenderness. These pointed to vitamin B 12 deficiency rather than Addison disease, which was thus not pursued. Modern approaches to the investigation of vitamin B 12 deficiency. Both responded well neutrophile treatment with vitamin B She was on a normal mixed diet and neither drank alcohol nor smoked.

It is not hypeesegmented to us what might have accounted for the high serum vitamin B 12 value, but high intrinsic factor antibodies have been reported hypersegmentee be a cause of such a finding. Clin Med Res ; 4: The greater number of cases may not have a typical presentation.


Hypersegmented neutrophils and oval macrocytes in the setting of B12 deficiency and pancytopaenia.

Elevated cardiac markers Elevated alpha-fetoprotein. She presented with dark pigmentation of hands and feet, weakness and recurrent blackouts for neutrophile weeks. The majority of neutrophils have three nuclear segments lobes connected by tapering chromatin strands. Retrieved from ” https: The patient in case 2, had hyperpigmentation, numbness and loss of reflexes, anaemia, macrocytosis and hypersegmented neutrophils: Had a mildly enlarged liver.

Published online Sep Nuclear hypersegmentation of DNA in neutrophils strongly suggests megaloblastosis when associated with macro-ovalocytosis.

After diagnosis of vitamin B 12 deficiency intramuscular injections of vitamin B 12 1 mg twice a week were given over the first 3 weeks, then 1 mg every 3 months to be continued for life. Case 3 was a year-old Ghanaian woman. Clinical spectrum and diagnosis of cobalamin deficiency.

She had experienced hypertension of duration 3 years that was well controlled on nifedipine. Hypersegmentation can also be seen in many other condition but with relatively less diagnostic significance.

She was unemployed, lived with her father and had two children. In case 1, the patient was initially managed as suspected haemolytic anaemia and depression with folic acid and tryptizol.

Hypersegmented neutrophil – Wikipedia

In spite of the high serum vitamin B 12 value, the patient was anaemic, showed hypersegmented neutrophils, weakness and hyperpigmentation. In other projects Wikimedia Commons. Desk Reference for Hematology, Second Edition.

Am J Hematol ; Haemolytic anaemia and depression. It is suggested from the literature that the high serum vitamin B 12 may have been the result of high intrinsic factor antibodies.


Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Case 2 was a year-old Ghanaian woman. Articles which use infobox templates with no data rows. Her serum vitamin B 12 level was low as expected. Hypersegmentation can sometimes be difficult to assert since interobserver variation is high, and important to note is that blacks have a greater neutrophil segmentation than whites [3] [4].

Megaloblastic anemia in North Africa. This led to a resolution of the dark urine colour and her Hb level neutrophisl to This report highlights the need for a pragmatic approach in diagnosing vitamin B 12 deficiency with a focus on history and clinical examination for neurological symptoms, hyperpigmentation, weakness and peripheral blood smears for macrocytosis with hypersegmented neutrophils.

Galloway M, Macrocytosis Hamilton M: Blood sugar Hypoglycemia Hyperglycemia Prediabetes Impaired fasting glucose Impaired glucose tolerance Oxyhyperglycemia. The presence of hypersegmented neutrophils is an important diagnostic feature gypersegmented megaloblastic anaemias.

Anderson’s Atlas of Hematology. Open in a separate window. Ivy Adwowa Efiefi Ekem.

Smudge cell Downey cell. Treatment is readily available for vitamin B 12 deficiency, so early recognition is important to ensure prompt replacement therapy.

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