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Blood film features:

  • Macrocytosis
  • Oval macrocytes
  • Teardrop cells
  • Anisopoikilocytosis can become marked in severe B12 deficiency, with RBC fragments and microcytes (dyserythropoietic features)
  • Neutrophil hypersegmentation
  • Eosinophils and basophils may also be hypersegmented
  • No polychromasia
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Bone marrow aspirate from a patient with megaloblastic anaemia. Use the settings toolbar to adjust the brightness if the image appears too dark.

Bone marrow features:

  • Nuclear-cytoplasmic asynchrony
  • Increase in basophilic erythroblasts
  • Reduction in myeloid:erythroid ratio
  • Giant metamyelocytes and band forms
  • Horseshoe-shaped nuclei in myeloid precursors

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