▁in ▁macro cy t ic - type ▁an em ias . ▁Some ▁of ▁these ▁path ologies ▁produce ▁slightly ▁different ▁sets ▁of ▁appearances ▁in ▁blood ▁cells ▁that ▁are ▁detect able ▁from ▁red ▁and ▁white ▁cell ▁morph ology , ▁and ▁others ▁are ▁only ▁detect able ▁with ▁chemical ▁testing . ▁ ▁C aus es ▁ ▁Meg al ob last ic ▁an em ias ▁Meg al ob last ic ▁an em ias ▁represent ▁a ▁type ▁of ▁macro cy t ic ▁an emia ▁character ized ▁by ▁certain ▁morph olog ic ▁ab normal ities ▁noted ▁on ▁a ▁peri pher al ▁blood ▁sm ear ▁exam ination . ▁These ▁ab normal ities ▁include ▁the ▁presence ▁of ▁en larg ed ▁o val ▁sh aped ▁red ▁blood ▁cells ▁( macro oval ocy tes ) ▁and ▁hyper segment ed ▁neut roph ils ▁( defined ▁as ▁a ▁neut roph il ▁with ▁six ▁or ▁more ▁lo bes ). ▁Hyper segment ed ▁neut roph ils ▁may ▁be ▁seen ▁in ▁the ▁absence ▁of ▁macro oval ocy tes ▁as ▁hyper segment ation ▁of ▁neut roph ils ▁is ▁an ▁early ▁sign ▁of ▁meg al ob last ic ▁an emia ▁and ▁may ▁preced e ▁the ▁appearance ▁of ▁macro oval ocy tes ; ▁they ▁may ▁also ▁be ▁seen ▁in ▁other ▁an em ias ▁( e . g ., ▁iron ▁def ic iency ▁an emia ) ▁and ▁thus ▁are ▁suggest ive ▁of ▁meg al ob last ic ▁an emia ▁but ▁not ▁specific ▁for ▁it . ▁An ▁increased ▁red ▁cell ▁distribution ▁width ▁( an is oc yt osis ) ▁also ▁suggests ▁meg al ob