Neutrophil hypersegmentation can be hereditary. It is also seen in megaloblastic hematopoiesis due to nutritional deficiencies, especially when seen with macrocytic ovalocytes. Both vitamin B12 and folate are crucial in DNA synthesis, so deficiencies in these vitamins cause delays in nuclear maturation.
Intrinsic factor is necessary for proper absorption of vitamin B12. This is why pernicious anemia, an autoimmune condition targeting intrinsic factor, leads to vitamin B12 deficiency. Since intrinsic factor is produced in the stomach, gastric bypass surgery can also lead to vitamin B12 deficiency. Vegetarians and vegans may suffer from this nutritional deficiency, as B12 is primarily found in animal sources. Intestinal issues such as Crohn’s or celiac disease can lead to deficiency from poor absorption.
Folate deficiency has several causes, including alcoholism, poor diet, intestinal issues causing poor absorption, and certain medications.
Hypersegmentation Appearance
Hypersegmented neutrophils have a nucleus with 6 or more lobes. The cell is usually larger than normal neutrophils.
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