This slide is also from a patient with B12 deficiency. The arrows indicate the macrometamyelocytes and the macrobands. It is not so easy to distinguish changes in the myelocytes and promyelocytes. One searches for abnormal granulocytes if one suspects a vitamin B12 or folic acid deficiency. If they are not present, then the possibilities to explain the abnormal red cells are primary or sideroblastic refractory anemia, erythroleukemia (Di Guglielmo's syndrome), metastatic carcinoma, granulocytic or myelomonocytic leukemia, preleukemia, dyserythropoiesis, or some other hematologic disorder. Macrometamyelocytes must be present to make a diagnosis of a true megaloblastic anemia from a bone marrow.
Course Section: 05. Nucleated Red Blood Cells
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