Schistocytosis in megaloblastic anemia masquerading peripheral blood picture as maha (microangiopathic hemolytic anemia) and decrease mean corpuscular volume

Abstract

Severe megaloblastic anemia presenting with hemolytic anemia, thrombocytopenia and schistocytosis resemble microangiopathic hemolytic anemia. Presence of scistocytes falsely decreases the Mean corpuscular volume. Toestimate the degree of schistocytosis in megaloblastic anemia with hemolytic blood picture and its correlation with the lowering of MCV. 60 cases of megaloblastic anemia.30 patients of megaloblastic anemia with hemolysis(cases) and 30 patients without hemolysis(clinical control)were taken. Complete blood count, Peripheral smear examination, schistocyte count, serum bilirubin, LDH, Homocystine was done. Mean age of clinical control group was 22 where as that of cases was 14.1 years. Mean serum homocysteine level was increased in both clinical control group and cases. In our study of 30 megaloblastic anemia patients with hemolysis (case), 29 had >1% of schistocytes in their peripheral blood picture. There is a positive correlation between percentage of schistocytes and homocysteine and a negative correlation between MCV and homocysteine. There is a statistically significant negative correlation existing between percentage of schistocytes and MCV.Presence of scistocytes in peripheral blood should not be always considered as MAHA, and lowering of MCV should not be confused as microcytic hypochromic anemia. Presence of macroovalocytes and hypersegmented neutrophils can be a clue for diagnosis of megaloblastic anemia with hemolysis in such type of cases.