Abstract :
Introduction: Severe megaloblastic anemia presenting with hemolytic anemia, thrombocytopenia and
schistocytosis resemble microangiopathic hemolytic anemia. Presence of scistocytes falsely decreases the
Mean corpuscular volume.
Aim: To estimate the degree of schistocytosis in megaloblastic anemia with hemolytic blood picture and
its correlation with the lowering of MCV.
Materials and Methods: 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.
Result: 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.
Conclusion: 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.
Keyword :
MAHA, Decrease MCV, Schistocytes, Hemolysis, Megaloblastic anemia.