The red blood cells in the sample are smaller than normal with increased central pallor, indicative of a hypochromic microcytic anemia with increased anisocytosis and poikilocytosis. This type of blood smear can be seen with hereditary abetalipoproteinemia, hereditary acanthocytosis, end stage liver disease, anorexia nervosa, malnutrition, post splenectomy, or intravenous hyperalimentation with intralipid infusion.

1. CASES - BLOOD
BY: AHMED ISMAIEL

7. 
The RBC's here are smaller than normal
and have an increased zone of central
pallor. This is indicative of a hypochromic
(less hemoglobin in each RBC) microcytic
(smaller size of each RBC) anemia. There
is also increased anisocytosis (variation in
size) and poikilocytosis (variation in
shape).

12. A) Identify the abnormality on peripheral smear?
B) Name 4 conditions where these cells can be seen.

13. ACANTHOCYTES ARE SEEN IN
• Hereditary abetalipoproteinemia
• Hereditary acanthocytosis
• End stage liver disease
• Anorexia nervosa
• Malnutrition
• Post splenectomy
• Intravenous hyperalimentation particularly
with intralipid infusion

14. Complete Blood Picture

15. 
18 month old
child with pallor
and cutaneous
markers at the
back with an
abnormal skeletal
profile. P/S was
consistent with
macrocytic

16. 
What is the most probable
diagnosis?

Name the cutaneous marker.

What malignancies are
expected in this patient?

17. 
Fanconi anemia

Café au lait spot

Acute leukemia

19. MEGALOBLASTIC
ANEMIA

24. 
The CBC here shows a markedly increased MCV,
typical for megaloblastic anemia. The MCV can
be mildly increased in persons recovering from
blood loss or hemolytic anemia, because the
newly released RBC's, the reticulocytes, are
increased in size over normal RBC's, which
decrease in size slightly with aging.