Hypersegmented neu trop h ills are seen in?

Ans. is 'c' i.e., Megaloblastic anemia o Earliest and characteristic finding of megaloblastic anemia is hypersegmented neutrophills (neutrophils with > 5 lobes). Diagnosis is made even if a single neutrophil with > 6 lobes is seen or >5% neutrophils with 5 lobes are seen.Other Features of megaloblastic anemia Peripheral bloodo Macrocytosis i.e., megaloblastic RBC - Due to nuclear/cytoplasmic asynchronyo Macrocytes lack central pallor of normal RBCo Anisopoikilocytosis - Marked variation in shape and sizeo Majority of RBCs appear as macroovalcytes.o Few tear drop cells.o Low reticulocyte counto Some nucleated RBCs may appear (normally, during maturation of RBC, nucleus disappears)o Large megakaryocytes with multilobate nuclei.o Evidence of erythropoiesis: - Basophilic stippling, Cabott Ring, Howell-jolly bodies.o As DNA synthesis is impaired in all proliferating cells, pancytopenia (anemia, leukopenia, thrombocytopenia) may occur.Bone marrowo Hypercellular due to proliferation of erythroid precursors replacing fat - Decreased ration of fat cells to hematopoietic elements (normal is 1:1).o Reversal of myeloid to erythroid ratio (normal is 2 to 3 : 1) due to proliferation of erythroid precursorso Megaloblastic erythropoiesisOtherso | MCV due to macrocytosiso | MCH due to increased hemoglobin content.o Normal MCHC because hemoglobin content in the cell is increased proportionate to increase in the size of RBC.o Increased serum LDH.