A 57-year-old woman complains of weakness, dyspnea, loss of appetite, and liquid feces. She has been suffering from this condition for 2 years. Objectively she presents with pale skin, subicteric sclera, and bright-red fissured tongue. Lymph nodes are not enlarged. Pulse – 100/min. BP- 105/70 mm Hg. Liver +3 cm, the spleen cannot be palpated. Blood test: erythrocytes – 1.2 × 1012/L, Нb- 56 g/L, color index – 1.4, macrocytes, leukocytes – 2,5 × 109/l, eosinophils – 1%, juvenile – 1%, metamyelocytes – 1%, band neutrophils – 8%, segmented neutrophils – 47%, lymphocytes – 38%, monocytes – 4%, reticulocytes – 0.1%, platelets – 100 × 109/l, ESR - 30 mm/hour, indirect bilirubin – 26 mmol/L. What changes can be expected in the bone marrow puncture material?

Answer options

1. Increased number of sideroblasts
2. Presence of blast cells
3. Prevalence of lymphoid tissue
4. Erythroid hyperplasia
5. Prevalence of megaloblasts

Explanation

A 57-year-old woman complains of weakness, dyspnea, loss of appetite, and liquid feces. She has been suffering from this condition for 2 years. Objectively she presents with pale skin, subicteric sclera, and bright-red fissured tongue. Lymph nodes are not enlarged. Pulse – 100/min. BP- 105/70 mm Hg. Liver +3 cm, the spleen cannot be palpated. Blood test: erythrocytes – 1.2 × 1012 /L, ?b- 56 g/L, color index – 1.4, macrocytes, leukocytes – 2, 5 × 109/l, eosinophils – 1%, juvenile – 1%, metamyelocytes – 1%, band neutrophils – 8%, segmented neutrophils – 47%, lymphocytes – 38%, monocytes – 4%, reticulocytes – 0.1%, platelets – 100 × 109/l, ESR- 30 mm/hour, indirect bilirubin – 26 mmol/L. What changes can be expected in the bone marrow puncture material? Megaloblastic anemia is characterized by red blood cells that are larger than normal. There also aren’t enough of them. It’s known as vitamin B-12 or folate deficiency anemia, or macrocytic anemia, as well. Megaloblastic anemia is caused when red blood cells aren’t produced properly.