3. macrocytic anemia

Question 1

what is seen in the blood smear of megaloblastic anemia (folate or B12 deficiency)?

Answer 1

neutrophil hyper-segmentation
macro-ovalocytes
anisocytosis
poikilocytosis

Question 2

diagnosis of folate (vitamin B9) deficiency?

Answer 2

folate ↓
RBC folate ↓
homocysteine ↑
methylmalonic acid normal (unlike B12 def.)

Question 3

management of folate deficiency?

Answer 3

folic acid 1-5 mg PO daily for 1-4 months

prophylaxis (400 mcg) - chronic dialysis patients, patients in total parenteral nutrition, pregnancy

Question 4

diagnosis of pernicious anemia

Answer 4

anti-IF Ab’s
gastrin levels ↑
schilling test
gastroscopy with biopsy

*with vitamin B12 deficiency–> B12 ↓, homocysteine and methylmalonic acid ↑

Question 5

management of severe B12 deficiency

Answer 5

1 mg hydroxocobalamin IM daily X 7 days –> once weekly X 4-8 weeks –> once monthly/ once 3 months for life

Question 6

what drugs cause drug-induced macrocytosis?

Answer 6

zidovudine
hydroxyurea
5-FU
cytarabine

Question 7

what type of non-megaloblastic anemia presents in infancy with macrocytosis +/- congenital malformation?

Answer 7

Diamond-Blackfan anemia

increases risk of malignancies and endocrine abnormalities

Question 8

liver disease-associated anemia?

Answer 8

macrocytic, non-megaloblastic anemia

seen with target cells