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Haematology > 2: Macrocytic anaemia and macrocytosis > Flashcards

2: Macrocytic anaemia and macrocytosis Flashcards

1
Q

What MCV defines macrocytosis

A

> 96

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2
Q

What are the 3 types of macrocytosis

A
  1. Megaloblastic
  2. Non-Megaloblastic
  3. Other
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3
Q

What are 3 causes of megaloblastic macrocytosis

A

Vitamin B12 Deficiency
Folate Deficiency
Anti-Folate Medications

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4
Q

How long do vitamin B12 stores usually last

A

3-5 years

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5
Q

What condition can lead to vitamin B12 deficiency

A

Pernicious anaemia

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6
Q

How long do folate stores last

A

3-months

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7
Q

What are 4 anti-folate medications

A

Trimethoprim
Phenytoin
Methotrexate
Hydroxyurea

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8
Q

What are non-megaloblastic causes of macrocytic anaemia

A 
Hypothyroidism 
Pregnancy 
Macrocytosis 
Reticulocytosis 
Liver Disease
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9
Q

What are 4 other causes of microcytic anaemia

A
  • MDS
  • MPD
  • Myeloma
  • Aplastic anaemia
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10
Q

Explain pathophysiology of macrocytic anaemia

A
  • Macrocytosis is due to a defect in DNA production
  • It is where cells do not have the correct number of DNA copies.
  • In response cells keep increasing in size
  • If too large cells will undergo intra-medullary haemolysis causing anaemia
  • To compensate bone marrow increases cell production resulting in megalocytosis
  • Megalocytosis also happens to other cells causing hyper-segmented neutrophil appearance
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11
Q

What is first-line in anaemia

A

FBC

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12
Q

What is looked at after FBC

A

Vitamin B12 and Folate

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13
Q

What is then looked at

A

Peripheral blood smear

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14
Q

What will be seen on peripheral blood smear

A

Hyper-segmented neutrophils if megaloblastic

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15
Q

When is a bone marrow biopsy indicated

A

If cause not identified by previous tests

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16
Q

How long does the body store folate for

A

3-months

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17
Q

Where is folate absorbed

A

Jejunum

18
Q

What can lead to folate deficiency

A
  • Alcoholism
  • Malnutrition
  • Increased demand: pregnancy, coeliac disease
  • Anti-Folate medications
19
Q

How is folate deficiency managed

A

Folic acid supplementation

20
Q

What should folic acid always be given with and why

A

B12.

If Folic acid is given in B12 deficiency it can precipitate subacute combined degeneration of the spinal cord

21
Q

How much folic acid is given routinely in pregnancy

A

400mcg

22
Q

What should always be given before folate

A

Vitamin B12

B4 Folate

23
Q

What is the role of vitamin B12

A

Vitamin B12 helps synthesise thymidine and therefore is required for RBC and DNA synthesis

24
Q

How long do vitamin B12 stores last

A

3-5 Years

25
Q

Where is vitamin B12 absorbed

A

Terminal Ileum

26
Q

What can cause vitamin B12 deficiency

A
  • Poor Intake

- Malabsorption

27
Q

What can lead to poor intake of vitamin B12

A

B12 is found in meat and fish - therefore vegans can be deficient

28
Q

What malabsorption conditions can lead to vitamin B12 deficiency

A
  • Pernicious anaemia
  • Gastrectomy

Conditions affecting terminal ileum:

  • Crohn’s
  • Ileal resection
  • Topical sprue
  • Bacterial overgrowth
29
Q

What dermatological feature has been described in vitamin B12 deficiency

A

Lemon-tinge to skin

30
Q

Why is a lemon tinge to skin described in vitamin B12 deficiency

A

Jaundice and anaemia

31
Q

What are neurological complications of vitamin B12 deficiency

A
  • Neuropsychiatric: Depression

- Neurological: Sub-acute combined degeneration spinal cord, peripheral neuropathy

32
Q

How does subacute combined degeneration spinal cord present

A

Mixed UMN and LMN. Often with classic triad of:

  1. Upgoing plantar
  2. Absent knee jerk
  3. Absent ankle jerk
33
Q

Explain pernicious anaemia

A

Autoimmune disorder causing atrophic gastritis and preventing parietal cells releasing IF which is required for absorption vitamin B12 in terminal ileum

34
Q

What are RF for pernicious anaemia

A
  • Over 40
  • Other autoimmune diseases
  • Blood-group A
35
Q

What cancer does pernicious anaemia increase risk of

A

Gastric carcinoma

36
Q

Explain FBC in pernicious anaemia

A

Macrocytic anaemia

37
Q

Explain vitamin B12 in pernicious anaemia

A

Low

38
Q

Explain parietal cell antibodies in pernicious anaemia

A

Parietal cell antibodies (90%)

39
Q

How is pernicious anaemia managed

A

IM Vitamin B12

40
Q

What is vitamin B12 called

A

Hydoxocobalamin

Haematology (19 decks)

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