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Anon left asks about this in rapid succession, so I guess that is my cue to talk about megaloblastic anemia, haha.
Megaloblastic anemia is a non-hemolytic anemia, usually attributed to either B12 deficiency (impaired absorption because of a gastrectomy, pernicious anemia, inflammation, or transcobalamin deficiency) or Folate deficiency (dietary, drug related impairment of use, loss though kidney). Both are cofactors in DNA synthesis, especially of thymidine. The result is nuclear cytoplasmic asynchrony wherein the nucleus matures slower than the cytoplasm, and you can see all the cells are a little off looking as a result.
In your smear, you won’t see much in the way of retics, but there will be extensive hypersegmentation of neutrophils, large platelets, huge macrocytes/macroovalocytes, tear cells, schistocytes, pancytopenia, and howell-jolly bodies. A few giant bands and metamyelocytes much sneak into the circulation too. Things are generally just. Big.
The bone marrow will have very distinct megaloblastic changees. The myeloid:erythroid ratio will be decreased but the marrow is almost always hypercellular. Very early erythroid precursors predominate over late precursors because of ineffective erythropoiesis. In contrast to the comically large myeloid precursors, megakaryocytes are small and hypolobated because they have so much DNA they are affected the most by impaired synthesis.
Burkitt’s Lymphoma, bone marrow touch prep + Wright’s stain
Extremely distinct, fairly uniform cells with super dark blue cytoplasm full of lipid vacuoles. It has an association with Epstein Barr virus, which is also the causative agent of infectious mono, hairy leukoplakia, and a whole host of other problems. What a tricky virus.
Chronic lymphocytic leukemia, peripheral smear.
90% of CLL cases occur in patients over 50 years of age. Picture perfect autoimmune hemolytic anemia (schistocytes, spherocytes, DAT positivity) presents in 15-35% of cases. Patients tend to survive for a very long time (5-20 years), and unlike CML, there is no blast crisis and they usually die of some other infection.
Its main hallmark is absolute lymphocytosis, and the lymphocytes have very clumpy chromatin that makes them look like soccer balls (alternatively, they all just break and you get a slide full of smudge cells). It’s extremely easy to pick out once you’ve seen it since, by lymphocytosis, I mean I had a patient today with a white cell count of 549x10^9/L (high normal is 11x10^9/L for our region).