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 greater number of cases may not have a typical presentation. In the diagnosis of megaloblastic anaemia, a thorough history and physical examination are essential. She presented with recurrent jaundice, malaise, insomnia, joint pain, numbness and dark urine for more than 84 weeks. Case 2 was a year-old Neutorphils woman.

Elevated cardiac markers Elevated alpha-fetoprotein. Intrinsic factor antibodies and vitamin B 12 metabolites have to be checked. Views Read Edit View history.

Hypersegmented neutrophil – Wikipedia

She was not pale but had hyperpigmented soles and palms, absent ankle and knee reflexes, and an arthritic left knee.

Abstract The present report concerns three cases of vitamin B 12 deficiency in Ghana. Desk Reference for Hematology, Second Edition. Galloway M, Macrocytosis Hamilton M: Clinical spectrum and diagnosis of cobalamin deficiency. Vitamin B 12 deficiency can present even in the face of high serum vitamin B 12 levels.

It is visualized by drawing blood from a patient and viewing the blood smeared on a slide under a microscope. As to whether this is the general trend in the country or not, would be ascertained as we keep accumulating data.


American Journal of Clinical Pathology. It is interesting that all the cases in the present report were women. At the time her Hb was 9. Treatment is readily available for vitamin B 12 deficiency, so early recognition is important to ensure prompt replacement therapy. In case 1, the patient was initially managed as suspected haemolytic anaemia and depression with folic acid and tryptizol. This page was last edited on 8 Decemberat Vitamin B 12 and megaloblastic anaemia in South African Bantu. Hypoglycemia Hyperglycemia Prediabetes Impaired fasting glucose Impaired glucose tolerance Oxyhyperglycemia.

Her serum vitamin B 12 level was low as expected. She was a retired educationist with adult children.

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

The major clinical features were weakness, joint pain and dark urine. 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.

The majority of neutrophils have three nuclear segments lobes connected by tapering chromatin strands. The third patient presented with haemolytic anaemia with depression, and was managed as such initially. Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies.

Nypersegmented Atlas of Hematology. Hypersegmentation persists for an average of 14 days after institution of specific therapy. These pointed to vitamin B 12 deficiency rather than Addison disease, which was thus not pursued.


She readily responded to treatment accompanied by a reversal of the hyperpigmentation, loss of her numbness, weakness and blackouts, a rise in Hb and normalisation of neutrophil segmentation. hypresegmented

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The need for a pragmatic approach in diagnosing vitamin B 12 deficiency is stressed. Hypersegmentation can also be seen in many other condition but with relatively less diagnostic significance. In spite of the high serum vitamin B 12 value, the patient was anaemic, showed hypersegmented neutrophils, weakness and hyperpigmentation.

Blood smear with two hypersegmented neutrophils. Megaloblastic anemia and other causes of macrocytosis.

The patient in case 2 had the typical textbook description of vitamin B 12 deficiency. Hypersegmented neutrophil Medical diagnostics Blood smear with two hypersegmented neutrophils.

Some of the most important pointers to vitamin B 12 deficiency in Ghanaians and thus probably West Africans are hyperpigmentation, neutrophil hypersegmentation, macrocytosis and neurological signs and symptoms.

The patient in case 2, had hyperpigmentation, numbness and neuttophils of reflexes, anaemia, macrocytosis and hypersegmented neutrophils: She presented with weakness, excessive salivation and anorexia for 24 weeks.