Dr. Ron’s Research Review – June 10, 2015

© 2014                                                                                                        

This week’s research review focuses on neutrophilic hypersegmentation.

A study published in the American Journal Of Clinical Pathology found that in subjects with normal or near-normal hematologic indices (hemoglobin, mean corpuscular volume), there was a significant negative correlation between average numbers of neutrophilic lobes and serum folate levels. Neutrophilic hypersegmentation was an indicator of incipient folic acid deficiency. (Bills and Spatz, 1977)

A recent study published in Clinical Laboratory found a correlation between neutrophilic hypersegmentation due to mild folate deficiency and decreased serum iron/ferritin levels in iron deficiency.

Ninety 16-30 year-old women were selected and divided into three groups: twenty nine iron deficient (ID), thirty to iron deficiency anemia (IDA), and thirty one control participants. Chi square tests showed statically significant differences in NH values among these three groups (p-value = 0.001), and a correlation between NH and decreased serum iron/ferritin levels (p-value = 0.001). With logistic regression analysis, it was observed that the relation between NH and ID/IDA is due to concomitant low normal folate levels (p-value = 0.044). The detection of NH in a peripheral blood smear of patients with ID/IDA is a possible reason for a coexistence of mild folate deficiency. It is suggested that in addition to ID/IDA, latent folate deficiency should be investigated in these patients. (Manavifar et al., 2014)

 

Dr. Ron


 

Articles

Neutrophilic hypersegmentation as an indicator of incipient folic acid deficiency
            (Bills and Spatz, 1977) Download
The authors have identified a group of subjects with neutrophilic hypersegmentation who are normal or near-normal with respect to other hematologic indices (hemoglobin, mean corpuscular volume). In a high proportion of these subjects, serum folate levels are abnormally low. In this group and a non-hypersegmented-neutrophil control group there was a significant negative correlation between average numbers of neutrophilic lobes and serum folate levels. In the subjects with hypersegmented neutrophils the predominant alteration is a shift from three-lobed to five-lobed neutrophils. It is believed that neutrophilic hypersegmentation can be a valuable adjunct in documenting and/or uncovering incipient folate deficiency.

The association between neutrophilic hypersegmentation and iron deficiency with regard to folate status in 16-30 year-old women
            (Manavifar et al., 2014) Download
INTRODUCTION: Neutrophilic hypersegmentation (NH) is a hematological anomaly that is mainly related to the deficiency of folic acid and/or cobalamin. There are also controversial studies showing that NH relates to iron deficiency anemia (IDA). The aim of this study was to investigate this relationship by comparing two groups: iron deficient (ID) and IDA. The effect of low normal folate level on this relationship was also investigated. METHODS: In this prospective cohort study, performed in Mashhad, Iran in 2011, ninety 16 - 30 year-old women were selected and divided into three groups, ID, IDA, and control. NH was examined in peripheral blood smears by two experts. CBC was done on a Sysmex K-21 hematologic analyzer. Colorimetric methods were utilized to measure the serum iron and total iron binding capacity. Serum ferritin as well as folate and cobalamin were measured by radioimmunoassay methods. Data was analyzed with SPSS 11.5 software. A p-value < 0.05 was considered to be significant. RESULTS: Twenty nine ID, thirty IDA, and thirty one control participants were studied. Chi square tests showed statically significant differences in NH values among these three groups (p-value = 0.001), and a correlation between NH and decreased serum iron/ferritin levels (p-value = 0.001). With logistic regression analysis, it was observed that the relation between NH and ID/IDA is due to concomitant low normal folate levels (p-value = 0.044). CONCLUSIONS: The detection of NH in a peripheral blood smear of patients with ID/IDA is a possible reason for a coexistence of mild folate deficiency. It is suggested that in addition to ID/IDA, latent folate deficiency should be investigated in these patients.

 

References

Bills, T. and L. Spatz (1977), ‘Neutrophilic hypersegmentation as an indicator of incipient folic acid deficiency’, Am J Clin Pathol, 68 (2), 263-67. PubMedID: 879101
Manavifar, L., et al. (2014), ‘The association between neutrophilic hypersegmentation and iron deficiency with regard to folate status in 16-30 year-old women’, Clin Lab, 60 (3), 517-22. PubMedID: 24697133