6 June 2017 (Tuesday) - Megaloblastic?



This case appeared in a Facebook group I follow:

90 y-o widower has been living by himself since his wife of 68 years passed away. He has been feeling weak. The following are his lab results:
WBC: 9.3 G/L;
RBC: 2.94 T/L;
Hgb: 114 g/L;
MCV: 118 fL,
Plt: 287 G/L.
Bili: 27 umol/L (RR: 0-18),
LDH: 222 U/L (RR: 210-290)
Included here are his peripheral blood images. What do you think his follow-up tests should be? What presumptive diagnosis can you make from the current results?

Well, there’s a hypersegmented neutrophil and macrocytosis. The chap fits the classic B12/folate deficient sort of person.
But the liver function… what’s going on there? Is that part of the megaloblastic process?

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