A 39-year-old man with chronic alcoholism is brought to the hospital after a fall, while intoxicated. He has completely recovered except for a bruise on his shoulder. His only abnormality is low hemoglobin of 9.6 g/dL, the platelets and WBC are normal. Additional tests including ferritin, vitamins B12, and folate are normal.
Which of the following findings is most likely to be seen on his peripheral blood film?
(A) macrocytosis
(B) basophilia
© red cell fragments
(D) increased platelet adhesiveness
(E) atypical lymphocytes
solution:
. (A) Macrocytosis is frequently seen in patients with chronic alcoholism for multiple reasons including vitamin B12 or folate deficiency, chronic liver disease, and also from the direct toxic effects of alcohol on red cells. Because both iron deficiency and folate deficiency are very common in alcoholics, a dimorphic blood
film can also be seen (macrocytes, hypersegmented neutrophils, and hypochromic microcytes
can be found) on the same slide