Chap 18

Question 1

Define Megaloblastic Anemia?

Answer 1

Abnormal DNA synth, usually due to B-12/Folate deficiency. Results in delayed nuclear dev causing large abnormal BM Eryth precursors.

Question 2

Megaloblastic and non-megaloblastic anemias are characterized by Erythrocytes W/ and increased MCV, which is?

Answer 2

MCV > 100

Question 3

Cellular observation of Megaloblastic anemia?

Answer 3

Large Nucleus
Plasm Dev normal
Hgb synth normal

Question 4

Clinicals findings in megaloblastic anemia?

Answer 4

Slow to dev

Fatigue

Weakness

Yellow Color

Weight loss

Glossitis

Question 5

Lab Features of megaloblastic anemia?

Answer 5

Macrocytic, Normochromic

Increased MCH (Large cell volume)

Normal MCHC

Decreased to Normal- RBC, Hgb, Hct

Reticulocytopenia

Grans hyper-seg.

Megakaryocytes abnormal (Thrombocytopenia)

Question 6

RBC Inclusions in Megaloblastic Anemia?

Answer 6

Oval Macrocytes

HJBs

Hyper-Seg Neuts

Cabot Rings

Aniso and Poik

RBCs fragile, Shortened lifespan
(Many die in the BM)

B/c RBCs die increased LDH

Question 7

BM feats in Megaloblastic Anemia?

Answer 7

Hypercellular ( Large Megaloblastic Erythroid Precursors)

M:E Ratio Decreased

Question 8

Megaloblastic Anemia Chemistry?

Answer 8

Decreased to Normal : B-12 and Folate

Homocysteine and Lactic Dehydrogenase (LDH) due to hemolysis

Question 9

Major Causes of Megaloblastic Anemia?

Answer 9

Vitamin B-12 deficiency

Folate Deficiency

Question 10

Vitamin B-12 Sources?

Answer 10

Red Meat

Fish

Eggs

Dairy Products

Shellfish

Question 11

The cause of pernicious anemia is?

Answer 11

Impaired absorption of B-12 due to an intrinsic factor deficiency.

Question 12

Sources of Folate are?

Answer 12

Leafy Greens

Dried beans

Liver

Beef

Fortified breakfast cereals

Some fruits (Oranges)

Question 13

Causes of folate deficiency?

Answer 13

Inadequate Intake
(Poor Diet)

Increased Need
(Pregnancy & Lactation)

Impaired Absorption
(Celiac Disease)

Excessive loss of folate
(Renal Dialysis)

Question 13

Tests utilized for Megaloblastic Anemia?

Answer 13

CBC

Retic Count

WBC Differential

Serum Bilirubin

Lactate Dehydrogenase

Question 14

Sequence of events for Megaloblastic Anemia?

Answer 14

1. Decrease in vitamin levels.
2. Hyper-Seg of Neuts in PB.
3. Oval Macrocytes in PB.
4. Megaloblastosis in BM.
5. Anemia

Question 15

Treatment of B-12 and folate deficiencies?

Answer 15

Directed @ specific deficiency

B-12: Injection intramuscularly to bypass need for intrinsic factor or High-dose orally (Pernicious).

Folate: Oral supplements

Question 16

W/ treatment of deficiency the body’s response is?

Answer 16

BM Morph reverts w/n a few hours of first treatment.

Substantial Retic response- 1week

Hyper-Seg Neuts- disappear from PB- 2 weeks

Hgb increasing to normal- 3 weeks

Question 17

Hematologic parameters may return to normal w/n?

Answer 17

3-6 weeks

Question 18

Correction of Megaloblastic Anemia may occur w/n?

Answer 18

6-8 weeks

Question 19

2 causes of Non-Megaloblastic Anemia?

Answer 19

Liver Disease

Chronic Alcoholism

BM Failure

Question 20

Schilling Test

Answer 20

establishes the cause of B-12 deficiency.

Question 21

How is the Schilling test performed?

Answer 21

2 parts:

 Part 1 abnormal only (Malabsorption)

 Part 1&2 abnormal (Pernicious)