This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Haematology, Subject name: Pathology
[{'content': 'The earliest manifestation of megaloblastic anemia is \nSelect and explain. \nA. Macrocytosis, B. Hypersegmented neutrophils, C. Basophilic stippling, D. Cabot ring', 'role': 'user'}, {'content': 'Answer: B \nExplanation: Peripheral blood pictureBone marrow picture1.Macrocytosis (| MCV, MCH. Normal MCHC)2.Peripheral smearMacroovalocytes Few nucleated RBCsEvidence of dyserythropoiesis like--Basophilic stippling-Cabot ring-Howell- Jolly bodies3.| Hb4.| Hematocrit 5.Reticulocyte count - Normal or mild decrease6.White cells- Leucopenia7.Hypersegmented neutrophils/ Macropolycytes- First manifestation 8.| Platelets9.Pancytopenia (10-20%)Lab investigations:10.Serum iron, ferritin - | in pure VitB12/ Folate defect11.Serum bilirubin & LDH |- due to hemolytic component12.Schillings test: Used to assess status of intrinsic factor (IF) & Vit B12 to distinguish pernicious anemia from other causes of Vit.B12 deficiency.1.Moderate- marked hypercellularity2.Erythroid hyperplasia3.M:E ratio reversal4.Ehropoiesis- Megaloblastic5.Giant metamyelocytes6.Mildly reduced megakaryocytes7.BM iron moderately increased in pure Vit B12/ Folate defects.(Ref: Harrison 18/e p866, 17/e p645-646, Tejinder Singh 2/e p54-61)', 'role': 'assistant'}]