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Anemias - continuation

Anemias - continuation. Blood Picture in Megaloblastic anaemia. 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 .

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Anemias - continuation

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  1. Anemias-continuation

  2. Blood Picture in Megaloblastic anaemia • 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. Film: Normochromic, Anisocytosis poikilocytosis, macrocytosis, tear drop cells

  3. Blood Film in Megaloblastic anemia Hypersegmented Neutrophils

  4. Normoblastic & Megaloblastic Erythropoiesis Megaloblastic Normoblastic

  5. 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.

  6. 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).

  7. IDA-blood film Hypochromic microcytic red cells, with some pencil cells and teardrop cells

  8. Blood film in Thalassaemia major Nucleated red cell Hypochromic , aniso-cytosis, poikilocytosis, target cells

  9. 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.

  10. Hb H preparation Golf ball appearance ( precipitated HbH in RBCs) New methylene blue stain

  11. Spherocytosis Discrimination by age of onset and Combs Test

  12. G6PD enzyme deficiency • The blood film shows irregularly contractedcells [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.

  13. 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.

  14. Positive Sickling test

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