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Haemotology > maacrocytosis and microcytic anaemia > Flashcards

maacrocytosis and microcytic anaemia Flashcards

1
Q

what is microcytic anaemia?

A

anaemia in which the red cells have a larger than normal volume

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2
Q

what is macrocytic anaemia?

A

anaemia in which the red cells have a larger than normal volume

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3
Q

what is the unit to measure MCV?

A

femtolitres (1 femtoliter is equal to 10^-15L)

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4
Q

how to measure MCV?

A

Modern analysers use the light scatter properties of red cells to measure the MCV.

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5
Q

normal size of the red cell is the same size as the

A

nucleus of the lymphocyte

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6
Q

what are the two causes of macrocytosis?

A

genuine (true) or spurious (false)

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7
Q

what are the two causes of true macrocytosis?

A

megaloblastic

non-megaloblastic

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8
Q

normal precurors of red cells excluding the reticulocyte are?

A

erythroblasts or normoblasts and have a nucleus (they are the same)

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9
Q

where are normal red cells precursors based?

A

marrow-based

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10
Q

what is the immediate precursor of the red blood cell?

A

reticulocyte (loses of nucleus) and have a small amount of RNA which is lost after about 24 hours

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11
Q

reticulocytes leave marrow to join

A

circulation

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12
Q

developing erythroblasts?

A

accumulate Hb
reduce in size and increasing nuclear maturation
stop dividing and lose nucleus

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13
Q

what triggers loss of nucleus and end of division?

A

critical Hb content

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14
Q

at the point the nucleus is lost and the division ends?

A

the erythroblast becomes a reticulocyte

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15
Q

between pronormoblaast and late normoblast cells are?

A

increasing in HB, becoming smaller still has nucleus

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16
Q

what is an megaloblast?

A

an abnormally large nucleated red cell precursor with an immature nucleus and more open chromatin and have a larger nucleus

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17
Q

what are the characteristics of megaloblastic anaemias?

A

lack of red cells due to predominant defects in DNA synthesis and nucleus maturation but RNA and hemoglobin synthesis are preserved

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18
Q

pro erythroblasts ——– but in ——— erythroblasts, division is ——- and apoptosis ———-

A

expand, reduced

increased

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19
Q

in a megaloblast what occurs normally?

A

cytoplasmic development and haemoglobin accumulation

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20
Q

megaloblasts are

A

precursors that are bigger with an immature nucleus

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21
Q

once the hemoglobin level in the cell is optimal the nucleus if extruded leaving behind ?

A

a bigger than normal red cell ie. microcyte

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22
Q

but overall in megaloblastic anaemia there are?

A

fewer macrocytes and hence anaemia

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23
Q

the end result after enucleation you go from megaloblast to

A

macrocyte

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24
Q

megaloblastic anaemia is?

A

charaacteristed by larger precursor cells with an immature nucleus leading to microcytic anaemia

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25
Q

what are the causes of megaloblastic anaemia?

A

B12 deficiency
folate deficiency
others such as drugs and rare inherited abnormalities

26
Q

why are B12 and folate essential co-factors?

A

they are co-factors in linked biochemical reaction regulating

27
Q

what are the functions of B12 and folate?

A

DNA synthesis and nuclear maturation - (e.g. blood cell effect)
DNA modification and gene activity – (e.g. nervous system)

28
Q

B12 is rich in which foods?

A

meat and meat products, eggs

29
Q

what is pernicious anaemia?

A

autoimmune condition with resulting destruction of gastric parietal cells

30
Q

gastric parietal cells produce?

A

Intrinsic factor

31
Q

with someone who have pernicious anaemia?

A

there is resulted in intrinsic factor deficiency with N12 malabsorption and deficiency

32
Q

what conditions are associated with pernicious anaemia?

A

associated with atrophic gastritis and personal or family history of other autoimmune disorders (eg. hypothyroidism, vitiligo, Addison’s disease)

33
Q

where is folate absorbed?

A

in jejunum via duff ion and active transport

34
Q

dietary floats are converted to?

A

mono glutamate

35
Q

folate deficiency can show up in?

A

4 months

36
Q

what is the daily dietary intake of folate?

A

200ug/day

37
Q

what is the daily requirement of B12?

A

1.5ug/day

38
Q

what are the causes of folate deficiency?

A

inadequate intake
malabsorption
excess utilisation
drugs

39
Q

what are examples of excesss utilization of folate?

A

hemolysis
exfoliating dermatitis
pregnancy
malignancy

40
Q

what are the clinical features of B12/folate deficiency?

A

symptoms/signs of anaemia
weightless, diarrhea, infertility
sore tongue, jaundice
developmental problems

41
Q

B12 deficiency causes

A

neurological problems - posterior/dorsal column abnormalities, neuropathy, dementia, psychiatric manifestations

42
Q

what is the laboratory diagnosis of B12.folate deficiency?

A 
microcytic anaemia (red cell count is low) 
pancytopenia (all cells low) in some patients
43
Q

assay B12 and folate levels in serum has a flaws such as?

A

: low levels may not indicate deficiency and normal levels may not indicate normalcy!

44
Q

check for autoantibodies?

A

(anti-intrinsic factor (IF) & anti gastric-parietal cell (GPC)

45
Q

what are the flaws of checking for auto-antibodies?

A

: anti-GPC sensitive, not specific; anti-IF: more specific, not sensitive)

46
Q

shilling’s test

A

not routinely used anymore

47
Q

bone marrow examination

A

not required usually

48
Q

treatment of megaloblastic anaemia?

A

treat cause where possible

folic acid tablets (5mg per day)

49
Q

in pernacious anaemia?

A

vitamin B12 (tydroxycobalamin) injections for life

50
Q

only if potentially life-threatening anaemia?

A

transfuse red cells

51
Q

in the absence of anaemia maacrocytosis

A

is due to alcohol, liver disease, hypothyroidism

52
Q

what are the marrow failure causes?

A

myelodysplasia
myeloma
aplastic anaemia

53
Q

spurious macrocytotsis?

A

the volume of the mature red cell is normal but the MCV is measured as high

54
Q

retiulocytosis?

A

An increase in reticulocyte numbers occurs as a marrow response to acute blood loss or red cell breakdown (haemolysis)

Reticulocytes are bigger than mature red cells and are analysed along with these for the MCV measurement.

55
Q

what is cold-agglutinins disease?

A

these are proteins that are activated at room temperature these clumps of agglutinated red cells and are registered as 1 giant cell

56
Q

upper limit of normal of mcv

A

is 105

57
Q

upper limit of normal of mcv

A

is 105

58
Q

patients with pernicious anaemia can be?

A

appear mildly jaundiced due to intramedullary hemolysis

59
Q

what is intramedullary haemolysis?

A

Red cells die prematurely in the marrow
Haemoglobin and lactate dehydrogenase (LDH) are released from dead red cells
Haemoglobin converted to bilirubin

60
Q

pancytopenia can complicate?

A

severe megaloblastic anaemia

Haemotology (7 decks)

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