—Clinical features include pallor and jaundice. The onset is gradual, and a severely anaemic patient may present in congestive heart failure or only when an infection supervenes. The blood film shows oval macrocytes and hypersegmented neutrophil nuclei (with six or more lobes). In severe cases, the white cell count and platelet count also fall (pancytopenia). The bone marrow shows characteristic megaloblastic erythroblasts and giant metamyelocytes (granulocyte precursors). Biochemically, there is an increase in plasma of unconjugated bilirubin and serum lactic dehydrogenase, with, in severe cases, an absence of haptoglobins and presence in urine of haemosiderin. These changes, including jaundice, are due to increased destruction of red cell precursors in the marrow (ineffective erythropoiesis).
Reff: ABC OF CLINICAL HAEMATOLOGY: Second Edition
Tidak ada komentar:
Posting Komentar