Approach to Macrocytic + Normocytic Anaemia

Question 1

MACRO

Blood film;
o ? ? in B12/folate deficiency, may reveal
other clues (e.g. ? cells in liver disease).

?/?;
o ?/? cause, raised ? in B12/folate deficiency.

Serum B12 / folate levels;
o Serum folate reflects ? intake, so many labs do ? ? folate.

Answer 1

hypersegmented neutrophils
target
lft
tft
thyroid/liver
bilirubin
recent
red cell

Question 2

MACRO

If B12 low;
o Anti-? cell Ab, anti-? Ab.
o ? test: distinguishes between pernicious anaemia and ? bowel disease (? B12 given with, and then without ?, amount of ? B12 excreted in ? then detected).

Answer 2

parietal
IF
schilling
small
radiolabelled
IF
labelled
urine

Question 3

MACRO

Bone marrow ?: ? suggest B12 / folate deficiency, also seen in ?
–> o ? suppression test: can be used to differentiate B12 / folate deficiency in vitro after bone marrow ?.

Answer 3

biopsy
megaloblasts
myelodysplasia
deoxyuridine
biopsy

Question 4

NORMO

Is there acute blood ? (Hb is a ?, so does not ? immediately, usually after ? replacement).
Is there underlying ? disease
Is it ? (see below).
Are other cell lines affected, i.e. ? ? failure

Answer 4

loss
concentration
fall
fluid
chronic
haemolytic
bone marrow

Question 5

Anaemia of chronic disease;

?-chromic or ?-chromic, rarely severe.
Seen in chronic ?, ?, ? and ? disorders.
Pathology involves predominant ? production in the bone marrow.

? serum iron, ? ferritin, ? TIBC, ? STR.

Answer 5

normo
hypo
infection
malignancy
CKD
rheum
WBC
low
raised
low
normal

Question 6

Bone marrow failure;

Hb, reticulocytes, WBC and platelets all ? ?.
There will be alterations on the ? ?, and these patients require a bone
marrow ?.
If there are no abnormal blasts in the pancytopenic marrow, the diagnosis is
? anaemia (idiopathic or due to ?).

Answer 6

equally low
blood film
biopsy
aplastic
drugs

Question 7

BM Failure

Other causes will be apparent on marrow examination, e.g. haematological
?, ? disease, myelo-? or myelo-?
? infection can also cause cessation of marrow erythropoiesis

Answer 7

malignancies
met
fibrosis
dysplasia
parvovirus