Folate deficiency hematological signs

The hematological signs of folate deficiency manifest first in the neutrophils and then in red blood cells. Normally, close to half of the neutrophils contain three lobes 20 to 40% have two lobes and 15 to 25% have four lobes. In folate deficiency, segmentation of the neutrophils increases cells with 6 to 10 lobes may be detected. The detection of three five-lobed neutrophils in a count of 100 neutrophils indicates the possibility of folate deficiency. Diagrams of normal and hypersegmented neutrophils are shown in Figure 9.20. 

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The second hematological sign of folate deficiency involves the pathway of red blood cell synthesis. Early erythroblasts accumulate in folate deficiency, initially in the bone marrow, where they can be easily detected by the clinician, and then in the bloodstream. Because of the large size of early erythroblasts, the marrow containing the accumulated cells is called a megaloblastic marrow. Generally, marrow samples are taken from the hip (pelvis), though they can also be taken from the sternum. 

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