Hypersegmented neutrophil
A hypersegmented neutrophil is a clinical laboratory finding. It is visualized by drawing blood from a patient and viewing the blood smeared on a slide under a microscope. Normally, the number of segments in the nucleus of a neutrophil increases as it matures and ages after the neutrophil is released into the blood from the bone marrow. Although normal neutrophils only contain three or four nuclear lobes (the "segments"), hypersegmented neutrophils contain six or more lobes.[1]
This can be difficult to assert since interobserver variation is high, and important to note is that blacks have a greater neutrophil segmentation than whites[2].
Association with other diseases
megaloblastic anemia
Hypersegmented neutrophils have classically been thought to be pathognomonic of the class of anemias called megaloblastic anemias (anemias caused by failure of bone marrow blood-forming cells to make DNA, often caused by vitamin B12 or folate deficiencies, or DNA-replication poisons). Note that pernicious anemia is a type of vitamin B12 deficiency, and as such, is expected to show hypersegmented neutrophils.
an early sign
One of the earliest, notable changes in the peripheral blood in megaloblastic processes is the appearance of hypersegmented neutrophils. Because of the short life-span of neutrophils, these abnormal hypersegmented neutrophils characteristically appear even before the onset of anemia in megaloblastic processes.[3] Such neutrophils are less often seen in the other classes of anemia, which together are far more common than megaloblastic types of anemia. However, as noted below, the use of hypersegmented neutrophils to diagnose type of anemia is limited by the fact that different types of nutrient deficiency anemia may coexist.[4]
iron deficiency anemia
Indeed, in seeming contradiction to this, several studies have strongly associated neutrophil hypersegmentation with iron deficiency anemia.[5] In one study 81% of children with iron deficiency had hypersegmented neutrophils, vs. 9% of controls.[6] The mechanism for hypersegmentation in iron deficiency is not yet clear, but has been suggested to be concurrent iron and vitamin deficiency.
other diseases[2]
- chemotherapy drugs: 5-fluorouracil or hydroxyurea
- steroid therapy for immune thrombocytopenic purpura
- myelofibrosis or chronic myelogenous leukemia
References
- ^ Clinical Laboratory Hematology, Shirly B. McKenzie and J. Lynne Williams - 2nd edition - Copyright 2010 - ISBN 978-0-13-513732-1
- ^ a b Canada, editors, John P. Greer, MD, Professor, Departments of Medicine and Pediatrics, Divisions of Hermatology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee ; Daniel A. Arber, MD, Professor and Vice Chair, Department of Pathology, Stanford University, Director of Anatomic and Clinical Pathology Services, Stanford University Medical Center, Stanford, California ; Bertil Glader, MD, Professor, Departments of Pediatrics and Pathology, Stanford University Medical Center, Stanford, California, Lucile Packard Children's Hospital, Palo Alto, California ; Alan F. List, MD, Senior Member, Department of Malignant Hematology, President and CEO, Moffit Cancer Center, Tampa Florida ; Robert T. Means Jr., MD, PhD, Professor of Internal Medicine, Executive Dean, University of Kentucky College of Medicine, Lexington, Kentucky ; Frixos Paraskevas, MD, Professor of Internal Medicine and Immunology (Retired), University of Mantioba Medical School, Associate Member, Institute of Cell Biology-Cancer Care, Mantioba, Winnipeg, Mantioba, Canada ; George M. Rodgers, MD, Professor of Medicine and Pathology, University of Utah School of Medicine, Health Sciences Center, Medical Director, Coagulation Laboratory, ARUB Laboratories, Salt Lake City, Utah ; Editor Emeritus, John Foerster, MD, FRCPC, Professor and Physician Emertius, Winnipeg, (2014). Wintrobe's clinical hematology (Thirteenth edition. ed.). p. 937. ISBN 1451172680.
{{cite book}}:|first1=has generic name (help)CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link) - ^ Kumar, Abbas, Fausto, Mitchell. Robbins Basic Pathology 8th ed. 2007. pg 437
- ^ Westerman DA, Evans D, Metz J.Neutrophil hypersegmentation in iron deficiency anaemia: a case-control study.Br J Haematol. 1999 Dec;107(3):512-5.
- ^ Westerman DA, Evans D, Metz J.Neutrophil hypersegmentation in iron deficiency anaemia: a case-control study.Br J Haematol. 1999 Dec;107(3):512-5.
- ^ Sipahi T, Tavil B, Unver Y. Neutrophil hypersegmentation in children with iron deficiency anemia. Pediatr Hematol Oncol. 2002 Jun;19(4):235-8. PubMed PMID 12051589.