Anemia: Megaloblastic, Pernicious, Folic Acid

Question 1

What are Megaloblastic Anemias?

Answer 1

• Disorders caused by impaired DNA synthesis that cause fragile megaloblasts (large RBCs)
• These RBCs are easily destroyed due to fragility thus resulting in anemic conditions

Question 2

Most megaloblastic anemias are a result of deficiency in

Answer 2

• Cobalamin (Vit B12)

* Folic acid

Question 3

What is the definition of pernicious?

Answer 3

• having a harmful effect, especially in a gradual or subtle way

Question 4

Pernicious anemia is caused by

Answer 4

• a lack of intrinsic factor

Question 5

What is intrinsic factor?

Answer 5

• A protein secreted by the parietal cells of the gastric mucosa which enables the body to absorb vitamin B12 at the end of the small intestine (ileum)
• No intrinsic factor = no cobalamin (B12) absorption

Question 6

What procedures/conditions may cause a lack of intrinsic factor?

Answer 6

• Gastrectomy/gastric bypass
• Resection of the ileum
• Crohn’s or celiac disease
• Diverticuli
• Basically anything that interrupts normal gastric or ileum function

Question 7

What is vitamin B12 used for?

Answer 7

• Keep body’s blood and nerve cells healthy
• Helps convert carbs to glucose for energy
• Helps synthesize DNA & form RBCs

Question 8

Unusual s/s of pernicious anemia?

Answer 8

• Red, BEEFY tongue
• Anorexia
• Paresthesias of hands and feet
• Ataxia
• Decrease of vibratory and position senses

Question 9

Treatment of pernicious anemia will involve cobalamin (VB12) supplements. What are the methods of admin?

Answer 9

• Oral
• Inhalant
• Injection

Question 10

For progressive pernicious anemia, what methods of cobalamin (VB12) will need to be used?

Answer 10

• Inhalant or injection

Question 11

How is initial and long-term cobalamin (VB12) treatment administered for pernicious anemia?

Answer 11

• 1000 mg of cobalamin IM daily for 2 weeks
• Then weekly until the hematocrit is normal
• Then monthly for life

Question 12

Which pts with pernicious anemia may take oral cobalamin or get it via food?

Answer 12

• Those who GI tract is completely intact and functioning

Question 13

True or False

As long as supplemental cobalamin is used, the anemia can be reversed.

Answer 13

• True w/ one exception

* If the person has had long-standing neuromuscular complications, they may not be reversible

Question 14

A pt w/ pernicious anemia should be frequently for what condition?

Answer 14

• Gastric carcinoma

Question 15

Folic acid is needed for

Answer 15

• DNA synthesis

* RBC formation and maturation

Question 16

What are common causes of folic acid deficiency?

Answer 16

• Dietary or malabsorption issues
• Drugs
• Alcohol abuse
• Anorexia
• Loss during hemodialysis

Question 17

What drugs interfere with the absorption of folic acid?

Answer 17

• Methotrexate (antineoplastic agent used to treat leukemia and other cancers)
• Antiseizure drugs (phenobarbital, diphenylhydantoin (Dilantin))

Question 18

Foods good for folic acid?

Answer 18

• Dark green leafy veg
• beans
• peanuts/seeds/whole grains
• fresh fruits
• seafood
• eggs