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Megaloblastic Anemia


This 68 year old male patient presented with a mild anemia in combination with a distinct macrocytosis, a decreased RBC concentration and an elevated MCH. Remarkably also is the neutrophil position in the SIZE/ COMPLEXITY scatterplot indicating that the neutrophils are larger than normal and based on this the CELL-DYN Ruby generated the BAND flag. Another notable observation is the high lobularity signal of the neutrophils, very well visible in the 90 º/WBC 0 º and the GRANULARITY/LOBULARITY scatterplots. The blood smear confirmed the presence of large (giant) neutrophils in combination with hypersegmentation. After additional investigations the patient was diagnosed with megaloblastic anemia due to vitamin B12 deficiency.

Numerical Results

WBC 7.72 10e3/μL
NEU 4.653 60.226 %  BAND
BLST 0.01 .014 %
MONe .656 8.49 %
EOS .181 2.34 %
BASO .054 .698 %
LYMe 2.175 28.255 %

RBC 2.67 10e6/μL
HGB 12.1 g/dL  SUSPECT
HCT 34.0 %
MCH 45.4 pg
MCHC 35.6 g/dL
RDW 13.4 %

PLT 332. 10e3/μL
MPV 6.54 fL

CELL-DYN Ruby Casebook. Megaloblastic Anemia. 2018. ADD-00005070. p.34
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