HOME HELP FEEDBACK SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Services Similar articles in this journal Alert me to new content in the Image Bank Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dawson, C. Articles by Lazarchick, J. Search for Related Content PubMed Articles by Dawson, C. Articles by Lazarchick, J. Related Collections Hemolytic Disorders Related ASH-SAP Chapter Related Image Bank Image Sets Related ASH Education Book Articles Social Bookmarking                   What's this?

Megaloblastic Anemia Secondary to Pyrimethamine

John Lazarchick

View larger version (66K): [in this window] [in a new window]   Figure 1. 51-year-old male was treated with pyrimethamine and sulfadoxine then later changed to pyrimethamine and clindamycin for CNS toxoplasmosis. He was not placed on leucovorin. Laboratory values on admission included a hemoglobin of 7.2g/dL, hematocrit of 19.8, WBC of 3.38k/µL, and a platelet count of 20,000/µL. The MCV was 103. Haptoglobin was <5.83mg/dL, and total bilirubin was 2.3mg/dL with a direct fraction of 0.7. LDH was markedly elevated at 2472 IU. Hypersegmented neutrophil (8 segments) is shown.

View larger version (88K): [in this window] [in a new window]   Figure 2. Marked megaloblastic changes seen in all stages of erythroid maturation: nuclear-cytoplasmic dysynchrony, open nuclear chromatin, and nuclear budding. Overall there is a decreased M:E ratio (myeloid to erythroid) secondary to a marked erythroid hyperplasia. 40X

View larger version (95K): [in this window] [in a new window]   Figure 3. At a higher magnification of previous image the open, sieve-like chromatin (salt and pepper) pattern in nucleus of megaloblastic cells is apparent. Howell-Jolly Bodies can be seen in orthochromatic nucleated red blood cells. Nuclear budding is seen on the orthochromatic cell.

View larger version (110K): [in this window] [in a new window]   Figure 4. Myeloid cells showing megaloblastic changes. Two giant bands are seen on the left of the field. One of these has features referred to as a "kissing band." In the right upper corner of the field a late erythroid form with nuclear budding is noted. 60X

View larger version (115K): [in this window] [in a new window]   Figure 5. A megakaryocyte with markedly increased nuclear lobulation is shown. 40X

View larger version (174K): [in this window] [in a new window]   Figure 6. Hypercellularity due to hyperplasia of all three cell lines is noted in this field. 20X

View larger version (173K): [in this window] [in a new window]   Figure 7. On higher magnification of the previous image, an increased number of immature, blast-like cells are apparent. Many of these cells contain one or more nucleoli. This may sometimes lead to an erroneous diagnosis of acute leukemia. 40X

View larger version (144K): [in this window] [in a new window]   Figure 8. In this field, a megakaryocyte is seen (small arrow) along with numerous blast-like cells (thick arrow). 40X

View larger version (182K): [in this window] [in a new window]   Figure 9. An immunohistochemical stain of the biopsy with Glycophorin A demonstrates a majority of the blast-like cells noted on the previous images to be erythroid precursor cells. 40X

CiteULike

Connotea

Del.icio.us

Digg

Reddit

Technorati

Related Image Bank Image Sets

Pernicious Anemia

Stanley Schrier
ASH Image Bank 2001 2001: 100231. [Full Text]

Acute Erythroid Leukemia

Peter Maslak
ASH Image Bank 2003 2003: 100635. [Full Text]

Acute Erythroid Leukemia

Peter Maslak
ASH Image Bank 2003 2003: 100840. [Full Text]

Erythroid Dysplasia

Peter Maslak
ASH Image Bank 2003 2003: 100895. [Full Text]

Refractory Anemia

Peter Maslak
ASH Image Bank 2004 2004: 101134. [Full Text]

Giant Metamyelocyte

Peter Maslak
ASH Image Bank 2005 2005: 101330. [Full Text]

Dysplastic Red Cell Changes (Bone Marrow Aspirate) II

Peter Maslak
ASH Image Bank 2006 2006: 600037. [Full Text]

Related ASH Education Book Articles

Update on Cobalamin, Folate, and Homocysteine

Ralph Carmel, Ralph Green, David S. Rosenblatt, and David Watkins
Hematology 2003 2003: 62-81. [Abstract] [Full Text]

Hematopathological Concepts and Controversies in the Diagnosis and Classification of Myelodysplastic Syndromes

James W. Vardiman
Hematology 2006 2006: 199-204. [Abstract] [Full Text]

Related ASH-SAP Chapter:

This Article Figures Only Services Similar articles in this journal Alert me to new content in the Image Bank Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dawson, C. Articles by Lazarchick, J. Search for Related Content PubMed Articles by Dawson, C. Articles by Lazarchick, J. Related Collections Hemolytic Disorders Related ASH-SAP Chapter Related Image Bank Image Sets Related ASH Education Book Articles Social Bookmarking                   What's this?