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T IoD haemaology > macrocytic anaemia > Flashcards

macrocytic anaemia Flashcards

1
Q

what type of anaemia is suggested with a high MCV?

A

macrocytic

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2
Q

what are two types of macrocytosis?

A

Megaloblastic

Non megaloblastic

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3
Q

what is the most common type of macrocytosis?

A

megaloblastic

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4
Q

what is meant by ‘megaloblastic anaemia?’

A

A type of macrocytic anaemia where there is a problem in DNA synthesis leading to megaloblasts going into circulation

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5
Q

what are two crucial things needed for normal DNA?

A

Vitamin B12

folate

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6
Q

what is a megaloblast?

A

An immature red blood cell that is large

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7
Q

what are causes of megaloblastic macrocytic anaemia?

A

folate deficiency
vitamin B12 deficiency
drugs that cause a deficiency in b12 or folate

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8
Q

what is folate necessary for?

A

Synthesis of adenosine, guanine and thymidine

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9
Q

what drugs can interfere with folate metabolism and absorption?

A 
methotrexate
metformin
antimicrobials( trimethorprim, sulfasalaine)
HIV meds
anticonvulsants
alcohol
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10
Q

what are causes of folate deficiency due to an increased demand by the body?

A 
Pregnancy
growth spurts
rapid cell turnover
disseminated cancer
urinary losses
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11
Q

what are causes of folate deficiency due to a decreased intake by the body?

A

Poor diet
elderly
chronic alcohol intake

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12
Q

what are causes of folate deficiency due to decreased absorption?

A

medications
coeliac disease
jejunal resection
tropical sprue

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13
Q

where is folate absorbed?

A

jejunum

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14
Q

how long does the body have stores of folate for?

A

3-5 months

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15
Q

what is the reticulocyte count in megaloblastic anaemia?

A

low because there is a problem with DNA production

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16
Q

what is seen on a blood film in megaloblastic anaemia?

A

anisopsoiilocytosis
macrocytes
ovalocytes
hypersegmented neutrophils

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17
Q

In megaloblastic anaemia you get hypersegmented neutrophils on a blood film, what do they look like?

A

a neutrophil with 5 or more lobes

18
Q

if you see hypersegmented neutrophils on a blood film what is the likely diagnosis?

A

megablastic anaemia

19
Q

a main cause of megablastic leukaemia is folate deficiency. what are symptoms of folate deficiency?

A

Sore mouth, ulcers, graying hair, fatigue, weakness, lethargy, pale skin, irritable

20
Q

what is the management for folate deficiency?

A
  • improve diet: broccoli, peas, brown rice

folic acid

21
Q

what drugs can cause macrocytosis?

A

HIV treatment: reverse transcriptase inhibitors
Anticonvulsants: valproic acid and phenytoin
folate antagonists: methotrexate
metformin

22
Q

how is vitamin B12 metabolised?

A

combines with methylmalonic acid(MMA) this produces CoA.

23
Q

what happens to the levels of methylmalonic acid in vit B12 deficiency?

A

MMA levels rise as there is no vit B12 for it to be bound with

24
Q

what is the link between vitamin b12 and homocysteine?

A

vitamin B12 metabolises homocysteine

25
Q

in vit B12 deficiency what happens to homocysteine levels?

A

they will rise as there isn’t enough B12 to metabolise it

26
Q

what is the recommended UK intake of b12?

A

1.5mcg

27
Q

where is vitamin B12 absorbed?

A

terminal ileum

28
Q

what is needed for the absorption of vit B12 in the terminal ileum?

A

intrinsic factor

29
Q

where is intrinsic factor produced?

A

parietal cells of the stomach

30
Q

what is responsible in the body for the transport of vit B12?

A

transcobalamin II and I

31
Q

what are causes of VIT B12 deficiency due to impaired absorption?

A

pernicious anaemia
gastrectomy or ileal resection
zollinger ellison syndrome
parasite

32
Q

what are causes of vit B12 deficiency due to decreased intake?

A

Malnutrition

vegan diet

33
Q

what are congenital causes of vit b12 deficiency?

A

intrinsic factor receptor deficiency

cobalamin mutation gene

34
Q

what are causes of vit b12 deficiency due to the body having increased requirements?

A

haemolysis
HIV
pregnancy
growth spurts

35
Q

what are examples of medications that cause vit B12 deficiency?

A

alcohol, metformin, PPI, h2 antagonist

36
Q

what is pernicious anaemia?

A

A cause of macrocytic anaemia as it causes a deficeincy in B12

an autoimmune disorder due to lack of intrinsic factor leading to a lack of b12 absorption

37
Q

what are clinical consequences of being B12 deficient?

A

decreased cognition, depression, psychosis, subfertility, cardiomyopathy. glossitis, taste impairment, pancytopenia

38
Q

what is a serious neurological disorder caused by B12 deficiency?

A

SACDC sub acute combined degeneration of the cord.

neuropathy, myopathy, sensory changes, ataxia, spasticity, gait abnormalities

39
Q

what causes SACDC?

A

a deficiency in B12 causes increased MMA this remains in the myeloid sheath
increased homocysteine cant be converted into methionine so can cause dementia and depression

40
Q

what is non megaloblastic anaemia?

A

Macrocytic anaemia; large, mature red blood cells not related to defective DNA synthesis

41
Q

what are causes of non megaloblastic anaemia?

A

chronic alcohol use, hypothyroidism, liver disease, myelodysplastic syndromes, haemolysis

T IoD haemaology (6 decks)

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