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Persistence of Neutrophil Hypersegmentation During Recovery from Megaloblastic Granulopoiesis

BARBARA J. NATH, M.D.; and JOHN LINDENBAUM, M.D.
[+] Article and Author Information

This study was supported in part by grant AA 00249 from the National Institutes of Health.

▸Requests for reprints should be addressed to John Lindenbaum, M.D.; Medical Service, Harlem Hospital Center; New York, NY 10037.


New York, New York


© 1979 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1979;90(5):757-760. doi:10.7326/0003-4819-90-5-757
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We studied the rate of disappearance of neutrophil hypersegmentation in 23 patients with megaloblastic anemia during therapy with vitamin B12 and folic acid. In 14 patients with uncomplicated megaloblastic anemia, the neutrophil lobe average began to fall towards normal 11.4 ± 0.3 (SEM) days after treatment was begun and became normal by 13.9 ± 0.6 days. In nine patients with associated inflammatory disorders, the lobe average returned to normal more rapidly. In six initially neutropenic patients, a five-fold increase in total granulocyte count occurred by the eighth day and a sevenfold increment in the total number of circulating hypersegmented neutrophils. Granulocyte folate concentrations in five folate-deficient patients rose to normal levels within 4 to 7 days of starting therapy. Hypersegmentation thus persists for many days after correction of neutropenia and restoration of normal granulocyte folate levels have occurred. We conclude that cobalamin and folate are needed at two different steps in granulopoiesis.

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