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Gwen - Haematology > Hyperchromic, Macrocytic anaemia > Flashcards

Hyperchromic, Macrocytic anaemia Flashcards

1
Q

If someone had macrocytosis, what investigations would you do?

A
  • B12/Folate Assay
  • LFTs, TFTs
  • Blood Film
  • Bone Marrow biopsy
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2
Q

What are causes of hyperchromic, macrocytic anaemia?

A
  1. B12/Folate Deficiency
  2. Alcohol excess/liver disease
  3. Reticulocytosis
  4. Cytotoxics
  5. Myelodysplastic syndromes - can progress to AML
  6. Marrow infiltration/Myeloma
  7. Hypothyroidism
  8. Myeloproliferative disorder
  9. Aplastic anaemia
  10. Anti-folate drugs (e.g phenytoin)
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3
Q

When is bone marrow biopsy indicated in macrocytic anaemia?

A

Indicated for when blood tests don’t reveal a cause

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4
Q

What can bone biopsy show in macrocytic anaemia?

A
  • Megaloblastic anaemia
  • Non-Megaloblastic anaemia
  • Abnormal erythropoeisis
  • Increased erythropoeisis
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5
Q

What are megaloblasts?

A

Anormally large nucelated red cell precursor with an immature nucleus.

Erythroblasts with delayed nuclear maturation because of d_efective DNA synthesis_ (megaloblasts). Megaloblasts are large and have large immature nuclei. The nuclear chromatin is more finely dispersed than normal and has an open stippled appearance.

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6
Q

What are non megaloblast?

A

Enlarged cells with a non immature nucleus

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7
Q

What are sources of folate?

A
  • Green vegetables
  • Nuts
  • Yeast
  • Liver
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8
Q

How long do body stores of folate last?

A

4 months

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9
Q

Where is folate absorbed?

A

Duodenum/proximal jejunum

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10
Q

What are causes of folate deficiency?

A
  • Poor diet - poverty, alcohol, elderly
  • Increased demand - pregnancy/increased cell turnover
  • Malabsorption - coeliac disease, tropical sprue
  • Drugs - anti-epileptics, methotrexate, trimethoprim
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11
Q

How would you manage someone with folate deficiency?

A
  • Treat the cause
  • Oral folate replacement
  • Ensure B12 normal if neuropathic symptoms
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12
Q

What dose of folic acid would you treat someone with for folate deficiency?

A

5mg/day - 4 months

NEVER WITHOUT B12 - unless patient is known to have normal B12

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13
Q

What is subacute degeneration of the spinal cord?

A

Degeneration of the posterior and lateral columns of the spinal cord as a result of vitamin B12 deficiency. It is usually associated with pernicious anemia.

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14
Q

Why does someone with B12 deficiency have a lemon yellow tinge?

A

Combination of anaemia and jaundice

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15
Q

What are the most common causes of B12 deficiency?

A
  • Dietary
  • Malabsorption
  • Congenital metabolic errors
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16
Q

What are malabsorptive problems that can lead to B12 deficiency?

A
  • Stomach - Pernicious anaemia, post gastrectomy
  • Terminal Ileum - Ileal resection, Crohn’s disease, bacterial overgrowth, tropical sprue, tapeworms
17
Q

What is pernicious anaemia?

A

An autoimmune disorder in which there is atrophic gastritis with loss of parietal cells in the gastric mucosa with consequent failure of intrinsic factor production and vitamin B12 malabsorption.

18
Q

What age does pernicious anaemia occur most commonly in?

A

Elderly

19
Q

What signs might be seen in pernicious anaemia and anaemia caused by B12 deficiency?

A
  • Lemon-yellow skin colour
  • Glossitis
  • Angular stomatitis
  • Vitiligo
  • Jaundice
  • Paraesthesiae
  • Peripheral Neuropathy
  • Neuropsychiatric problems
20
Q

How long do signs/symtpoms take to develop in pernicious anaemia?

A

1-2 years

21
Q

What investigations would you do for someone with suspected pernicious anaemia?

A
  • Bloods - FBC, MCV, Serum B12, Reticulocyte
  • Blood Film
  • Bone marrow
  • Parietal cell/intrinsic factor antibodies
    • ​Anti gastric parietal cell
    • Anti-intrinsic factor
22
Q

How would you manage someone with B12 deficiency?

A

If malabsorption, B12 injections:

  • Hydroxocobalamin - 1mg IM injection alternate days for 2 weeks, then 1mg injections every 3 months

If dietary, then oral B12

23
Q
A
24
Q

What neurological problems can occur in B12 deficiency?

A
  • Paraesthesiae
  • Peripheral neuropathy
  • Subacute degeneration of the spinal cord
25
Q

What are neuropsychiatric features of B12 deficiency?

A
  • Irritability
  • Depression
  • Psychosis
  • Dementia
26
Q

What are features of subacute combined degeneration of the spinal cord?

A

Symmetrical Peipheral Sensory neuropathy + UMN + LMN signs

  • Classic triad - extensor plantars, absent knee jerks, absent ankle jerks
  • Preserved pain and temperature - spinothalamic tracts preserved
  • Ataxia - due to loss of proprioception
  • Stiffness and weakness - tend to follow ataxia
27
Q

What tracts are commonly affected in subacute combined degeneration of the spinal cord?

A

Dorsal columns and corticospinal tracts

28
Q

What is often the first thing to go in subacute combined degeneration of the spinal cord?

A

Proprioception and vibration

Gwen - Haematology (33 decks)

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