Which of the following would be an unusual finding in megaloblastic anemia?
a. Marked polychromasia on the blood film
b. Hypersegmented neutrophils
c. Oval macrocytes
d. Pancytopenia
ANS: A
Ineffective erythropoiesis leads to intracellular death so that many red cells never make it to circulation; thus polychromasia is not typical. However, hypersegmented neutrophils are a hallmark, and, in fact, appear before changes in red cells are obvious. This is because of their short T1/2 of 6 to 10 hours in circulation. Oval macrocytes are a characteristic red cell shape in the megaloblastic anemias, and pancytopenia is usually present because all proliferating blood-forming cells in the bone marrow require normal DNA synthesis.
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