Hypersegmented neutrophils: blood film

Hypersegmentation is an excessive number of nuclear lobes in a neutrophil. Interpret this morphological finding alongside blood counts and context.

Identify granular cytoplasm, then follow the fine bridges between lobes. Examine several neutrophils and other cell lines in a well-spread area.

Both visible purple cells have nuclei divided into numerous lobes. The field also contains red cells with varying size and shape.

Vitamin B12 or folate deficiency is one possibility; medication can also affect maturation. Here, the author reports chemotherapy.

Do not confuse connected lobes of one nucleus with overlapping cells. Dysplasia requires assessment of the whole film and clinical context.

Review haemoglobin, MCV, reticulocytes and other cytopenias. Ask about medication, diet, malabsorption and neurological symptoms.

Neurological findings with suspected B12 deficiency require prompt care. Pancytopenia with fever or bleeding needs urgent assessment.

The film alone cannot diagnose autoimmune gastritis. Absence of macrocytosis or anaemia also does not exclude B12 deficiency.

Name hypersegmentation, then evaluate possible causes; respect the source context rather than assigning an undocumented aetiology.

• NICE NG239 — Vitamin B12 deficiency (2024) ↗
• Ed Uthman — document iconographique original / original image ↗

Documentary review: 2026-10-16