Anemias caused by Defects of Metabolism

Question 1

Hallmark of the disease affecting DNA metabolism

Answer 1

Megaloblastic Anemia

Question 2

Impaired DNA synthesis such as reduction in the number cell divisions usually result to these

Answer 2

Megaloblastic anemia

Question 3

Two vitamins that plays an important role in DNA synthesis of cells

Answer 3

Vit. B12 (cobalamin)

Folate

Question 4

Basic structure of cobalamin

Answer 4

includes tetrapyrrole ring (corrin) with a central cobalt atom linked to 5-6 dimethylbenzimedazoyl ribonucleotide

Question 5

Function of folate in the body

Answer 5

transfer carbon units in the form of methyl group

Question 6

In what form do folate circulates predominantly in blood

Answer 6

as 5-methyl THF (tetrahydrofolate)

Question 7

This type of anemia is characterized by decrease in intracellular folate and accumulation of homocysteine thus resulting to diminished thymidine availability

Answer 7

Megaloblastic Anemia

Question 8

What do the nuclei of Megaloblastic erythroid looks like

Answer 8

have an open finely stippled reticular patterns

Question 9

What is usually the cause behind the nuclear changes seen in Megaloblastic anemia

Answer 9

cell cycle delay
prolonged resting phase
arrest in nuclear maturation

Question 10

It is an autoimmune disorder resulting from a deficiency in the production of red blood cells through a lack of vitamin B12.

Answer 10

Pernicious anemia

-impaired absorption of Vit. B12

Question 11

Symptoms for folate and Vit. B12 deficiency

Answer 11

Glossitis
Neurologic symptoms including memory loss, numbness
Personality changes
Psychosis

Question 12

The absorption of vit b12 can be impaired by

Answer 12

• failure to separate vit. B12 from food proteins
• failure to separate Vit. B12 from haptocorrin in small intestine
• lack of intrinsic factor
• competition for available vit. B12

Question 13

Coo-cobalamin malabsorption is commonly caused by?

Answer 13

atrophic gastritis or atrophy of the stomach lining

Question 14

Five test used to screen for megaloblastic anemia

Answer 14

CBC
Reticulocyte count 
WBC manual differential 
Serum bilirubin 
Lactate dehydrogenase

Question 15

Result for CBC and Reticulocyte count in px with Megaloblastic anemia

Answer 15

↓

• Hgb (7-8 g/dL)
• Hct (20% - MGA may be seen in peripheral blood)
• Reticulocyte count (impaired cell production)

↑

• MCV (100-150, usually >120 fL)
• MCH ( increased volume of cell)
• RDW

N
- MCHC (hgb production is unaffected)

Question 16

Morphologic findings of megaloblastic anemia in the peripheral blood

Answer 16

Oval macrocytes (enlarged oval RBC)
Hypersegmented neutrophils w/ six or more lobes

Question 16

Morphologic findings of megaloblastic anemia in the peripheral blood

Answer 16

Oval macrocytes (enlarged oval RBC)
Hypersegmented neutrophils w/ six or more lobes

Question 17

Morphologic findings of megaloblastic anemia in the peripheral blood

Answer 17

Oval macrocytes (enlarged oval RBC)
Hypersegmented neutrophils w/ six or more lobes

Question 18

These laboratory findings can all be observed in megaloblastic anemia

Answer 18

Nucleated RBC 
Pancytopenia
Reticulocytopenia 
Howell-Jolky bodies
Basophilic stippling 
Cabot rings

Question 19

When should hypersegmentation be reported in cases of Megaloblastic anemia

Note: Mean lobe count should be >3.4

Answer 19

When atleast 5 lobed neutrophils per 100 WBCs or at least 1- six lobed neutrophil is noted

Question 20

Bilirubin and Lactate dehydrogenase levels in megaloblastic anemia

Answer 20

↑

• Total and indirect bilirubin
• Lactate dehydrogenase

LDH is high in cases of anemia

Question 21

Differentiating hallmark between Macrocytic Nonmegaloblastic and Macrocytic megaloblastic

Answer 21

Lack of hypersegmented neutrophils and oval macrocytes

Question 22

How do the cytoplasm and nucleus looks like in cells with megaloblastic anemia

Answer 22

pinkish-blue cytoplasm & nucleus appears younger and bigger for thr stage