Q. I’m confused how in megablastic anemia, cells become macrocytic due to immature nuclei when RBCs don’t have nuclei!Â Is it referring to the erythroblast precursors before the nuclei are lost?
A. Great question. In megaloblastic anemia, cells have a hard time making DNA (because there’s a lack of B12 and/or folate) – but RNA production proceeds normally. So you end up with cells that have normally maturing cytoplasm, but slowly-maturing nuclei. This means that the cell grows pretty large before the nucleus gets mature enough to signal division (so the cells end up being larger than normal). Also, when you look at the nucleus, it looks more immature than the cytoplasm (hence the term “nuclear-cytoplasmic asynchrony). You’re right: these changes are easiest to see when you look at erythroblast precursors (which have nuclei). You can also see the same changes in neutrophil precursors (you’d have to look at the marrow to see both of these types of precursor cells).
When you look at the blood, you can’t see these precursors. But you do see macrocytes (larger-than-normal mature red blood cells) and hypersegmented neutrophils. The reason the mature red cells are bigger than usual has to do with the fact that the red cell precursors get bigger than normal before each cell division, as described above…and that translates into bigger-than-normal mature (non-nucleated) red blood cells. The reason for the hypersegmented neutrophils is less clear; it has something to do with the abnormal, asynchronous maturation going on in the neutrophil series – but how the mature neutrophil winds up with a nucleus with more lobes (or segments) than normal is kind of a mystery.
this is very beautiful pic.
Great explanation!!! Really helpful!
Thanks,very simple and well explained!!
Thanks, really helpful explanation. Can anyone tell me though, is that a megaloblast at the bottom? Very rare to see one in the peripheral blood, no?
Thanks, Simon. No – that’s just a lymphocyte. Yes – it would be extremely uncommon to see a megaloblastic erythrocyte in the blood. They’re easy to spot in the marrow, though – they’re the cells with mature cytoplasm (maybe a little pink with hemoglobin) but immature chromatin (like an early erythroblast). Plus they’re huge (hence the prefix megalo-).
Could be a MCV 104.5 risk for developing megaloblastic anemia ? There is a RBC = 4.2milion and Hb = 14.0 g/dl ( men ).
With an MCV of 104.5, you’re in the macrocytic range. You’d need to take a look at a blood smear to see what is going on – if there are hypersegmented neutrophils (which you see in megaloblastic anemia) or dysplastic neutrophils (which you see in myelodysplasia). The patient’s not anemic – so it’s kind of weird. Any other CBC abnormalities? I’d get a blood smear and go from there.
very nice article and useful info
thanks for sharing this
Can anyone count how many nuclear lobes that neutrophil has?
Looks like 6 lobes to me!
Can the enlargement of red blood cells cause them to explode and then develop into the next type of anemia?
Good question, Aya! No – the red cells in macrocytic anemias don’t get bigger and bigger and then explode – they just reach a certain size and stay that way. Great question though!
Great question, Aya! The red cells in macrocytic anemias don’t get bigger and bigger until they explode – they just reach a certain size and remain intact. Great thought though!