Macrocytic Anaemia

Question 1

Macrocytic anaemia causes

Answer 1

Megaloblastic → B12/folate
Non-megaloblastic → Alcohol

Question 2

What are megaloblasts

Answer 2

RBC precursors
Immature nucleus (low B12/folate) with mature cytoplasm

Question 3

Source of B12

Answer 3

Meat and dairy

Question 4

Source of B12

Answer 4

Meat and dairy

Question 5

Causes of B12 deficiency

Answer 5

Diet
Malabsorption - gastric (pernicious anaemia), ileal (coeliac, Crohn’s, tropical sprue), nitric oxide abuse

Question 6

Clinical features of B12 deficiency

Answer 6

Mouth - glossitis, angula cheilosis
Neuropsych - mood/memory changes
Neuro - paraesthesia, peripheral neuropathy

Question 7

Mechanism of pernicious anaemia

Answer 7

Autoimmune atrophic gastritis → achlorhydria and lack of gastric IF
Anti-parietal, Anti-IF

Question 8

Mx of pernicious anaemia

Answer 8

IM hydroxycobalamin 6x in 2/52

Question 9

Folate source

Answer 9

Green vegetables

Question 10

Folate deficiency causes

Answer 10

Poor diet
Pregnancy
Malabsorption
Drugs/alcohol

Question 11

Drugs that can cause folate deficiency

Answer 11

Anti-epileptics (phenytoin)
Trimethoprim
Methotrexate

Question 12

Folate deficiency treatment

Answer 12

Check B12 and replace if needed
oral folic acid
B12 before folate