Macrocytic Anaemia

Question 1

What is Macrocytic Anaemia?

Answer 1

Anaemia where the blood cells produced are larger than normal and occurs where there a problems making new haemoglobin

Question 2

What is the difference between megaloblastic and non-megaloblastic?

Answer 2

In megaloblastic there is delayed nuclear maturation with the cytoplasm so the cytoplasm appears much bigger

Question 3

What are the causes of Megaloblastic? (3)

Answer 3

B12 deficiency, folate deficiency, cytotoxic drugs

Question 4

What are the causes of non-megaloblastic?

Answer 4

Alcohol, reticulocytosis, liver disease, hypothyroidism, pregnancy

Question 5

What are the most common causes?

Answer 5

Medication 37%, Alcohol 26%, B12/Folate 6%

Question 6

Who does it affect?

Answer 6

More females, aged around 60 years old

Question 7

Signs and Symptoms

Answer 7

*young people can be relatively anaemic and asymptomatic, shortness of breath on exertion, fatigue, palpitations, angina exacerbations, pale pallor, bounding pulse, systolic pulmonary flow murmur

Question 8

Investigations?

Answer 8

FBC, Blood Film, Serum Folate, Serum B12, LFT, TFT, Urinalysis, U&E, Coombs test to exclude haemolytic, Bone marrow biopsy

Question 9

Treatment (4)

Answer 9

Treat the cause/correct the deficiency e.g give B12 injections (check folate first), prophylactic folate in pregnancy, alcoholism management, refer if neurological symptoms are present (Acute Degeneration of the Spinal Cord)

Question 10

Are there any complications?

Answer 10

Acute Degeneration of the Spinal Cord (can be sped up when B12 is given in folate deficiency without folate supplements)