U world question Basophilic Stippling in B12 deficiency

[medInUSA]

Just did a U world question which presented macrocytic anemia, but also basophilic stippling

the answer was B12 deficiency,

and in the explanation they say that basophilic stippling is distractor here. WTF???

From Williams Hematology:

BASOPHILIC STIPPLING
Basophilic stippling consists of granulations of variable size and number that stain deep blue with Wright stain. Electron microscopic studies have shown that punctate basophilia represents aggregated ribosomes. 56 Clumps form during the course of drying and postvital staining of the cells, much as "reticulum" in reticulocytes precipitates from ribosomes during supravital staining. The clumped ribosomes may include degenerating mitochondria and siderosomes. In conditions such as lead intoxication and thalassemia, the altered reticulocyte ribosomes have a greater propensity to aggregate. As a result, basophilic granulation appears larger and is referred to as coarse basophilic stippling.

I have never read anywhere that Basophilic Stippling can be present in B12 deficiency. Has anybody???

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[Rendar5]

Just did a U world question which presented macrocytic anemia, but also basophilic stippling

the answer was B12 deficiency,

and in the explanation they say that basophilic stippling is distractor here. WTF???

From Williams Hematology:

BASOPHILIC STIPPLING
Basophilic stippling consists of granulations of variable size and number that stain deep blue with Wright stain. Electron microscopic studies have shown that punctate basophilia represents aggregated ribosomes. 56 Clumps form during the course of drying and postvital staining of the cells, much as "reticulum" in reticulocytes precipitates from ribosomes during supravital staining. The clumped ribosomes may include degenerating mitochondria and siderosomes. In conditions such as lead intoxication and thalassemia, the altered reticulocyte ribosomes have a greater propensity to aggregate. As a result, basophilic granulation appears larger and is referred to as coarse basophilic stippling.

I have never read anywhere that Basophilic Stippling can be present in B12 deficiency. Has anybody???

The section you just quoted explains why basophilic stippling can appear anytime you stain RBCs. I think the point was that basophilic stippling doesn't really guide you in the differential workup when you're looking at macrocytic anemia

 

[MedLover25]

It's a stupid question based on what you presented, but I'm sure there's more to it that may have led you to b12 (neuro problems???)

 

[Rendar5]

It's a stupid question based on what you presented, but I'm sure there's more to it that may have led you to b12 (neuro problems???)

Well, if you've got an MCV greather than 100, then B12 deficiency is already number 2 on the differential anyway. All you need is to know that there isn't folate deficiency (number 1), or that there's a risk factor for B12 def. in the PSH or diet. Hopefully B12 def. is found before the non-anemic symptoms set in, though not always.

 

[MedLover25]

True, but there are other causes of macrocytic anemia (B12 and folate produce a megaloblastic, macrocytic anemia --> so ALL cells appear bigger than normal)

 

[wmc24]

i just came along this question today. it was pretty obvious with the medications the patient was on and mcv of 107 that it was macrocytic anemia due to folate defiency. i think sometimes we just think too much into a question and tell ourselves that lab values they give us are wrong. take ur anemia question, look at the mcv like goljan taught us, and work from there.

 

[Rendar5]

The key with anemia is that you don't start a differential based around anemia. you start a differential around microcytic anemia, normocytic anemia, and macrocytic anemia.
The other way to divide anemias is into hemolytic and nonhemolytic by looking at bilirubin levels.

Once you figure out the more specific differential that you're going to form, then you can look at the important details instead of trying to incorporate every detail.

 

[pzh200707]

Since the basophilic stippling is an advanced form of reticulocyte, I don't think basophilic stippling is specific for B12 def where the reticulocyte account is low.