A hematopathological analysis on 16 cases of the megaloblastic changes was made by
the bone marrow examinations in the Department of Clinical Pathology of the Catholic
Medical Center from September 1967 to August 1979.
For each of these cases, Wright stained peripheral blood smears and bone marrow
smears, and hematoxylin-eosin stained bone marrow tissue sections (needle aspiration
particle) in addition to the clinical and laboratory records were reviewed and their
findings reappraised.
The results were as follows:
1. Male to female ratio was 9 : 7. Age distribution was diffusely scattered.
2. Among the 11 cases associated with underlying diseases, 3 cases were leukemias,
and 2 cases adenocarcinoma of the stomach, 2 cases liver cirrhosis, 2 cases pregnancy,
1 case hyperthyroidism with iron deficiency anemia, and 1 case postgastrectomy
malabsorption syndrome.
3. In the laboratory data, moderate or severe anemia was observed in all recorded
cases. The lowest value of the hemoglobin was 3.5gm/dl. and the highest 9.0gm/dl.
4. In the peripheral blood findings, the morphology of the erythrocytes showed marked
macrocytosis in 8 cases, moderate macrocytosis in 5 cases and mild macrocytosis in the
remaining 3 cases. Nucleated erythrocytes were found in 8 cases. Howell-Jolly bodies
were observed in two cases.
The number of leukocytes revealed slight decrease in 7 cases, normal limit in 4 cases
and mild to marked increase in the remaining 5 cases. The shift toright of neutrophils
with granulocytopenia were observed in 7 cases and those without granulocytopenia in 9
cases. The number of platelets revealed mild decrease in 7 cases, and moderate decrease
in 3 cases. In the remaining 6 cases, 5 cases revealed normal morphology and number,
but 1 case showed frequent giant platelets.
5. The bone marrow findings revealed hypercellularity in 10 cases and normocellularity
in 3 cases recorded. In the bone marrow morphology, as judged by the Wright stained
smears and hematoxylin-eosin stained tissue section particles, the erythrocytic
hyperplasia was found in the 13 cases. Marked meagloblastic changes were observed in
the 1 case of stem cell leukemia, 1 case of the adenocarcinoma of the stomach and 3
cases of unknown cause. Moderate megaloblastic changes were found in 4 cases. One of
them was the case of acute lymphocytic leukemia, one hyperthyroidism, one liver
cirrhosis and remaining one being unknown disease. The maturation pattern and
morphology of granulocytic precursors were normal in 10 cases.
The enlargement of granulocytic precursors was observed in 4 cases.
One of them was the case of liver cirrhosis, one hyperthyroidism and two unknown
disease. The leukemic myeloblasts were found in 1 case of actue granulocytic leukemia.
The number of megakaryocytes revealed normal limit in 5 cases, slight decrease in 10
cases and moderate increase in 1 case. A marked hypersegmentation of nucleus of the
megakaryocytes were found in 2 cases.
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