Hemeonc 3

Question 1

larger than normal erythrocytes with insufficient amount of Hgb

Answer 1

Macrocytic anemia

Question 2

Deficiency in folate or B12

Answer 2

Megaloblastic anemia

Question 3

What happens in your body without sufficient folate and B12?

Answer 3

Ineffective production of RBC’s, WBC’s, and PLT’s
Slows DNA production (cell growth)
B12 specifically related to myelin production

Question 4

What will you see on a PBS for megaloblastic anemia? If you see these things, what should you order next?

Answer 4

1) Hypersegmented neutrophils
2) Macroovalocytes (big ovals)
Order Folate and B12 levels

Question 5

How does B12 deficiency anemia typically present?

Answer 5

severe anemia with Hgb<6
Macrocytes
+/- neuro signs (which can be initial symptom…look for dementia, neuropathy)

Question 6

What part of the GI tract absorbs dietary B12?

Answer 6

Ileum (distal small bowel)

Question 7

“tending to cause death”

Answer 7

Pernicious

Question 8

What factors can cause B12 deficiency

Answer 8

**malabsorption (most common: Crohn’s, alcohol, antacids, pancreatic insufficiency)
radiation, surgery
pernicious anemia (missing intrinsic factor)
dietary deficiency (comes from meat)

Question 9

What factors can cause folate deficiency

Answer 9

1 is alcoholism

dietary deficiency (comes from leafy greens)
increased demand (pregnancy, SS, hemolysis)
malabsorption
drugs (sulfa, anti epileptics, HIV meds)

Question 10

An increase in both MMA (methymalonic acid) and HC (homocysteine) will indicate

Answer 10

Vitamin B12 deficiency anemia

Question 11

An increase in HC with normal MMA will indicate

Answer 11

Folate deficiency anemia

Question 12

Define non-megaloblastic anemia

Answer 12

Large RBC’s, no deficiencies in B12 or folate