Macrocytic anaemia

Question 1

Non-megaloblastic causes of macrocytic anaemia: 4

Answer 1

• alcohol - most common
• liver disease
• reticulocytosis
• hypothyroidism, pregnancy
• myelodysplasia

Question 2

Vit B12:

• sources (2)
• caues of def (2)

Answer 2

Sources - Meat & diary; we have large body stores

Dietary e.g. vegans

Malabsorption:

• stomach (Lack of IF which is produced by gastric parietal cells > Pernicious anemia), post gasterctomy
• Ileal resection, CD

Question 3

Clinical features of B12 def (6)

Rx (1)

Answer 3

• mouth - glossitis, angular cheilosis
• neuropsych - dementia, depression, psychoses
• neuro - parasthesia, absent ankle reflexes, peripheral neuropathy

Rx - give IM hydroxocobalamin (B12)

Question 4

Folate sources(3)

Causes of def (4)

Rx (1) & contraindication

Answer 4

Sources - green veg, nuts, yeast, liver (low body stores)

Def

• poor diet
• increased demand - pregnancy, increased RBC turnover
• Malabsorption - coeliac
• Drugs - alcohol, methotrexate, anti-epileptics e.g. phenytoin

Rx - oral folic acid. NB - if cause of anemia not known then folic acid should not be given as it will exacerbate the neuropathy of B12 def