Macrocytic anaemia

Question 1

define microcytic anaemia?

Answer 1

anaemia associated with a high MCV of erythrocytes

Question 2

what are the two types of macrocytic anaemia?

Answer 2

there is Megaloblastic and normoblastic anaemia

Question 3

what is megaloblastic anaemia caused by?

Answer 3

• Caused by deficiency of B12 or folate

Question 4

what are causes of low B12?

Answer 4

• Reduced absorption (e.g. post-gastrectomy, pernicious anaemia, terminal ileal resection or disease)
• Reduced intake (vegans)

Question 5

what are causes of folate deficiency?

Answer 5

• Reduced intake (alcoholics, elderly, anorexia)
• Increased demand (pregnancy, lactation, malignancy, chronic inflammation)
• Reduced absorption
• Jejunal disease (e.g. coeliac disease
• Drugs (e.g. phenytoin)

Question 6

which drug might cause megaloblastic anaemia?

Answer 6

• Methotrexate

Question 7

causes of normoblastic anaemia?

Answer 7

o	Alcohol excess  
o	Liver disease  
o	Myelodysplasia 
o	Multiple myeloma 
o	Hypothyroidism  
o	Haemolysis

Question 8

who does microcytic anaemia commonly affect?

Answer 8

ELDERLY FEMALES

Question 9

presenting symptoms of microcytic anaemia?

Answer 9

o	Tiredness  
o	Lethargy  
o	Dyspnoea 
•	Family history of autoimmune disease  
•	Previous GI surgery

Question 10

signs of microcytic anaemia on examination?

Answer 10

•	Signs of Anaemia 
o	Pallor  
o	Tachycardia  
o	Breathlessness  
•	Signs of Pernicious Anaemia 
o	Mild jaundice  
o	Glossitis  
o	Angular stomatitis  
o	Weight loss  
•	Signs of B12 Deficiency 
o	Peripheral neuropathy  
o	Ataxia  
o	Subacute combined degeneration of the spinal cord  
o	Optic atrophy  
o	Dementia

Question 11

first line investigation into microcytic anaemia?

Answer 11

• Bloods (haematinics)

* High MCV

Question 12

second line investigation into microcytic anaemia?

Answer 12

• Blood Film
o Large erythrocytes = normoblastic
• Megaloblasts
• Hypersegmented neutrophil nuclei = macroblastic

Question 13

what does the schilling test assess?

Answer 13

o Method of testing for pernicious anaemia

Question 14

management plan for macrocytic anaemia?

Answer 14

• B12 deficiency – MUST BE TREATED FIRST
o IM 1 mg
hydroxycobalamin every 2-3 months for life

• Folate Deficiency
o Oral folic acid

• Dietary advice
o Good sources of B12 e.g. Eggs, meat, salmon

Question 15

complications of pernicious anaemia?

Answer 15

increased risk of gastric cancer

Question 16

complications of folate deficiency on pregnancy?

Answer 16

folate deficiency increases the risk of neural tube defects