#00065935

A 68-year-old female, known case of chronic kidney disease (CKD) with uremia, presented for routine hematological evaluation. The complete blood count (CBC) revealed normocytic, normochromic indices (Hb 10.5 g/dL, MCV 100.1 fL, MCH 33.9 pg, MCHC 33.3%), with leukopenia (WBC 2.3 ×10³/µL) and platelet count was within normal limits (180 ×10³/µL).

Peripheral smear examination showed normocytic normochromic red cells with occasional hypersegmented neutrophils (more than six lobes), without accompanying macrocytosis. Barr body also noted. No blasts or immature granulocytes were identified.(Wright–Giemsa stain, 1000× oil immersion).

In this context, the presence of hypersegmented neutrophils in a uremic CKD patient likely represents uremia-related dysmyelopoiesis or metabolic interference with DNA maturation rather than classical megaloblastic anemia.

Hypersegmented neutrophils may occasionally be observed in CKD and uremia due to chronic metabolic stress, folate metabolism interference, or oxidative damage to hematopoietic precursors. Correlation with serum B₁₂, folate, and renal parameters is advised to rule out overlapping nutritional deficiency.