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PATHOMA > Ch. 5 - Macrocytic anemia > Flashcards

Ch. 5 - Macrocytic anemia Flashcards

1
Q

What is the MCV in macrocytic anemia?

A

> 100

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2
Q

What are folate and Vit B12 used for that causes anemia?

A

synth of DNA precursors

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3
Q

What is the form of folate that circulates in the body?

A

methylated THF

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4
Q

Describe the passage of the methyl group from folate to allow for DNA precursor synth?

A

methyl-THF to methyl-Vit B12 to homocysteine which then becomes methionine

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5
Q

What is another name for vitamin b12?

A

cobalamin

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6
Q

What leads to the size of the cells increasing in megaloblastic anemia?

A

lack of b12 or folate to make DNA keeps the erythroblast from undergoing its last division, so each cell is a little large

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7
Q

Impaired division of granulocytic precursors in megaloblastic anemia leads to (blank)

A

hypersegmented neutrophils

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8
Q

In what other cells do we see megaloblastic changes?

A

intestinal cells

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9
Q

in nonmegaloblastic macrocytic anemia, what changes do you NOT see?

A

hypersegmented neutrophils and megaloblastic changes in cells other than RBCs

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10
Q

Where is folate derived?

A

green vegetables and some fruits

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11
Q

Where is folate absorbed?

A

jejunum

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12
Q

How long does it take for folate deficiency to develop? What does this tell us about the body stores?

A

takes a few months, body stores are minimal compared to vit. b12

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13
Q

What are the three most common causes of folate def?

A
  1. poor diet (kids and elderly)2. increased demand (pregnancy, cancer, hemolytic anemia)3. folate antagonists (methotrexate
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14
Q

What enzyme does methotrexate inhibit?

A

dihydrofolate reductase

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15
Q

how many lobes does a PMN need to be hypersegmented?

A

more than 5

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16
Q

What are the lab values in folate def for the following:1. serum folate2. serum homocysteine3. serum methylmalonic acid

A
  1. decreased serum folate2. increased homocysteine (in both folate and B12 def)3. normal methylmalonic acid (increased for b12)
17
Q

Glossitis is a finding in (folate/b12/both)

A

both

18
Q

What is the dietary source of B12?

A

complexed with animal protein

19
Q

What enzyme liberates b12 from the protein complex?

A

salivary amylase

20
Q

B12 is bound by R-binder in what part of the body?

A

in the mouth

21
Q

Where is intrinsic factor produced? Where does it bind to b12?

A

made by the parietal cells in the body of the stomach but doesn’t bind to b12 until in the terminal ileum

22
Q

Where is b12 absorbed?

A

absorbed complexed to IF in the terminal ileum

23
Q

How long does it take to develop a b12 def? what does this tell us about the body’s stores of b12?

A

takes years; liver is loaded with b12

24
Q

(blank) detaches b12 from R-binder

A

pancreatic enzymes

25
Q

how does pancreatic insufficiency cause b12 def. anemia?

A

no pancreatic enzymes means no separation of b12 from R binder

26
Q

What is pernicious anemia?

A

autoimmune destruction of the parietal cells of the stomach and under production of intrinsic factor leading to b12 def. anemia

27
Q

What diseases cause damage to the terminal ileum that results in b12 megaloblastic anemia?

A

Crohn’s disease and fish tapeworm Diphyllobothrium latum

28
Q

T/F: there are hypersegmented PMNs in b12 def. anemia

A

true

29
Q

What is the unique clinical finding that separates b12 def from folate def?

A

subacute combined degeneration of the spinal cord leading to losses in vibratory sensation and proprioception

30
Q

how does b12 def cause spinal cord damage?

A

lack of b12 means that methylmalonic acid cannot be converted to Succ-CoA. Methylmalonic acid impairs spinal cord myelinzation

31
Q

What tract of the spinal cord is used for vibratory sensation?

A

posterior column

32
Q

What tract of the spinal cord is used for proprioception?

A

lateral corticospinal tract

33
Q

What are the lab values in b12 def anemia for:1. serum b122. serum homocysteine3. methylmalonic acid

A
  1. low b122. high homocysteine3. high methylmalonic acid
34
Q

Where is R-binder and IF resorbed?

A

terminal ileum

35
Q

Goat milk can cause a decrease in (b12/folate) absorption

A

folate

36
Q

What drugs often inhibit folate uptake?

A

5-FUMTXTpm-sfxPhenytoinOcp’setoh

37
Q

Pernicious anemia is seen in what blood group?

A

Group A

38
Q

What form of hypersensitivity is pernicious anemia?

A

type II; autoimmune destruction of parietal cells and Abs that block B12-IF binding

39
Q

T/F: anemia is not necessarily present with nonmegaloblastic macrocytosis

A

true

PATHOMA (11 decks)

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