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Red cell changes in top, middle and bottom layer of packed red cells in vitamin B12 deficiency. Relation to treatment.

Surviving macroreticulocytes are released to peripheral blood during the first 4 d following a B12 injection to vitamin B12 deficient patients with grave anaemia. Marked increase in number of reticulocytes, together with corresponding reduction in reticulocyte size is noted in the top layer of the centrifuged packed red column from d 4 to 6 after medication. This 'remodelling' of the 'stress-reticulocytes' seems best explained by a division of the cells into 2 equal, surviving, normal-sized reticulocytes. The macroreticulocytes, which probably result from skipped division in the marrow, may thus complete their last cytoplasmatic division in the peripheral blood. The numerous schistocytes, which are found in the top layer of the centrifuged packed red cell column, disappear during the first few days after treatment, and it is assumed that these cells are fragments from the relatively few megalocytes which have reached the peripheral blood prior to medication. Macroreticulocytes seem to have a maximum deformability on d 5 after the B12 injection, shortly after the cell division has started.