Since macrocytosis is the earliest finding seen in patients with folate or vitamin B12 deficiency in most cases the classic expression of vitamin B12 deficiency is a macrocytic anaemia
with accompanying elevated MCV.15 Similar to the study by Savage et al there was statistically significant increase in MCV levels in patients with macrocytic anaemia
Serum B12 deficiency can occur without Macrocytic anaemia
and blood changes as patients with neurological deficits due to vitamin B12 deficiency have absent haemotogical features.
is often attributed to deficiencies in Vitamin [B.sub.12] (cobalamin) and/or folate.
In the USA and other high-income countries, the majority of folate tests are done to investigate macrocytic anaemia
in non-pregnant patients.
Dimorphic anaemia can occur when iron deficiency anaemia responds to iron therapy, after the transfusion of normal blood to a patient with hypochromic anaemia, sideroblastic anaemia, refractory anaemia, macrocytic anaemia
, post transfusion, unmasking of iron deficiency following treatment of megaloblastic anaemia, delayed transfusion reactions and dual deficiency of iron and either vitamin B12 or folic acid (4) which is the focus of our study.
Eighty-one (31.8%) had normocytic normochromic anaemia, 13 (5.1%) had normochromic features with anisocytosis, 15 (5.9%) had normochromic macrocytic anaemia
, 8 (3.1%) had polychromasia with anisocytosis, and 22 (8.6%) had dimorphic features.
Caption: Peripheral Smear (100x) of Macrocytic Anaemia
12 patients had microcytic hypochromic anaemia, 3 had macrocytic anaemia
and 17 had normocytic normochromic anaemia.
This leads to the release of immature RBCs called macrocytes, which function less efficiently and produce macrocytic anaemia
. Deficiency of the maturation factors also affects the WBCs which can be detected by the presence of hypersegmented neutrophils in the peripheral smear.
Anaemia was noticed in fourteen cases- normocytic normochromic anaemia was seen in six cases, macrocytic anaemia
was seen in five cases, dimorphic anaemia was seen in three cases.
Comparison of Peripheral Blood Smear in Alcoholic and Non-alcoholic Patients Peripheral Blood Alcoholics Non Smear (n=185) (n=315) Normocytic Normochromic 13(7%) 23(7%) Anaemia Normal 48(26%) 197(63%) Macrocytic Anaemia
48(26%) 32(10%) Microcytic hypochromic Anaemia 28(15%) 37(12%) Dimorphic Anaemia 32(17%) 11(4%) Thrombocytopenia 9(5%) 10(4%)
The types of anaemia mainly based on peripheral smear and the common morphological patterns seen among the study group was normocytic normochromic anaemia (68.9%) followed by microcytic, hypochromic (27.7%), macrocytic anaemia
(1.5%) and dimorphic (1.9%) [Fig.