Welcome to keshvi’s page.
Contributor score: 8
be kind to yourself, doc! (it's a long road we're on!)
Hi, can someone explain the blood smear? isn't it supposed to show hypersegmented neutrophils if it was B12 deficiency?
I think the blood smear is showing a lone lymphocyte, which should be the same size as a normal RBC. You can see the RBCs in this smear are bigger than that ->macrocytic ->B12 deficiency
maybe i'm new to the game. but isn't the answer folate deficiency and not B12? Also, i though it was anemia of chronic disease as well.
Lispectedwumbologist, please explain your mistake? Lol because that seems like a respectible answer to me...
It's a B12 deficiency
Ileum is where B12 is reabsorbed, folate is jejunum
The blood smear is showing enlarged RBCs
Methionine synthase does this conversion, using cofactor B12
Anemia of chronic disease is a microcytic anemia -- I believe this is why they put a lymphocyte on the side -- so we could see that it was a macrocytic anemia.
Thanks NBME, that really helped me....
the question was relatively easy, but the picture was so misguiding i felt! i thought it looked like microcytic RBCs. I guess the key is, that they clearly mentioned distal ileum. and that is THE site for B12 absorption.
I didn't even register that was a lymphocyte. I thought I was seeing target cells so I was confused AF
Leave it to NBME to find the palest macrocytes on the planet.
so i guess size is more important than color cause those are hypochromatic as fuck
The NUCLEUS of a lymphocyte should be the same size as a normal RBC, which is not the case here. Under normal circumstances RBCs are not as big as lymphocytes, so this is truly extraordinary = megaloblastic anemia.