Work the functional-marker case

The qualified smear review reports macro-ovalocytes, anisopoikilocytosis, and hypersegmented neutrophils, with no blasts reported. Reflex chemistry drawn the same day shows B12 188 pg/mL, MMA 0.48 micromol/L, homocysteine 24 micromol/L, creatinine 0.82 mg/dL, and serum folate 8.1 ng/mL. These values are not a treatment decision or a local reflex algorithm.

The low reticulocyte response plus macro-ovalocytes and hypersegmented neutrophils supports impaired DNA synthesis rather than a reticulocytosis pattern. B12, MMA, and homocysteine together support a B12-deficiency pattern because renal function is not elevated here. The result set does not establish etiology or a treatment plan.

Pancytopenia requires qualified morphology review and communication under the local morphology-review and critical/escalation procedure. Neurologic urgency belongs to clinical correlation, not a laboratory diagnosis. Communicate the documented pattern and escalation finding, not an unsupported final diagnosis.