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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Ivy Adwowa Efiefi Ekem. She had difficulty in walking and felt numb in both feet.

In this report, three cases of vitamin B 12 deficiency in Ghana are presented that highlight some important laboratory and clinical observations that may be helpful for diagnosis in West Africa. Smudge cell Downey cell. One case presented in the expected textbook manner with neurological signs, anaemia and a low serum vitamin B 12 level, whereas another presented with anaemia and hyperpigmentation, but a high serum vitamin B 12 level.

Am J Med ; The major clinical features were weakness, joint pain and dark urine. Please review our privacy policy. The patient in case 2, had hyperpigmentation, numbness and loss of reflexes, anaemia, macrocytosis and hypersegmented neutrophils: Clin Med Res ; 4: Vitamin B 12 deficiency is the primary cause of megaloblastic anaemia in Zimbabwe.

The third patient presented with haemolytic anaemia with depression, and was managed as such initially. Author information Copyright and License information Disclaimer. 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.

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Hypersegmentation persists for an average of 14 days after institution of specific therapy. She had macrocytosis, occasional normoblasts and no hypersegmentation on her hypersegmennted film. She presented with recurrent jaundice, malaise, insomnia, joint pain, numbness and dark urine for more than 84 weeks. Open in a separate window. She had no medical history of note.

She was not pale but had hyperpigmented soles and palms, absent ankle and knee reflexes, and an arthritic left knee. The majority of neutrophils have three nuclear segments lobes connected by tapering chromatin strands.

Blood smear with two hypersegmented neutrophils.

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. Support Center Support Center. This is a clinical laboratory finding.

The present report concerns three cases of vitamin B hyeprsegmented deficiency in Ghana. At the time her Hb was 9. Wintrobe’s Atlas of Clinical Hematology. Published online Sep Articles which use infobox templates with no data rows. She was pale, had hyperpigmented soles and palms as well as abdominal tenderness.


Vitamin B 12 and megaloblastic anaemia in South African Bantu. Desk Reference for Hematology, Second Edition. She responded well, with a normalisation of haemoglobin levels. The serum vitamin B 12 estimation had been performed by the same laboratory using the same method of chemiluminescence assay, an automated non-isotopic no-boil assay.

In other projects Wikimedia Commons. Retrieved from ” https: Intrinsic factor antibodies and vitamin B 12 metabolites have to be checked. A positive Schillings test for malabsorption for all of them would have further supported a diagnosis of pernicious anaemia but could not be performed.


Hypersegmented neutrophil – Wikipedia

Diagnosis of cobalamin deficiency I: Both htpersegmented well to treatment with vitamin B Views Read Edit View history. Ivy Adwowa Efiefi Ekem, moc. Hypoglycemia Hyperglycemia Prediabetes Impaired fasting glucose Impaired glucose tolerance Oxyhyperglycemia.

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 need for a pragmatic approach in diagnosing vitamin B 12 deficiency is stressed.

She was continued on folic acid and steroids were added. In all three cases, no family member had had such an ailment.

Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies.

Hypersegmented neutrophil

Galloway M, Macrocytosis Hamilton M: As to whether this is the general trend in the country or not, would be ascertained as we keep accumulating data. The presence of hypersegmented neutrophils is an important diagnostic feature of megaloblastic anaemias. Elevated cardiac markers Elevated alpha-fetoprotein. She presented with weakness, excessive salivation and anorexia for 24 weeks.