Macrocytic Anaemia

Question 1

Define Macrocytic anaemia

Answer 1

Anaemia where the MCV reaches >100

Question 2

Ix of Macrocytic anaemia

Answer 2

Bloods
LFT
TFT
Se B12
Red Cell Folate

Film
Low B12/Folate will show Hyperpigmented PMN and Oval Macrocytes - Megaloblasts
EtOH/Liver failure will show Target cells.

Question 3

Causes of Non-megaloblastic anaemia

Answer 3

Alcohol and Liver disease
Myelodysplastic Syndromes
Congenital BM failure syndromes

Question 4

What is Meylodysplastic syndrome

Answer 4

Heterogeous group of disorders resulting in BM failure
Hypercellular Bone marrow and pancytopenia
Precursor to AML

Question 5

Features of MDS

Answer 5

Anaemia
BM Failure: infection, Bleeding, Bruising
Splenomegaly

Question 6

Ix of MDS

Answer 6

Film - blasts, cytopenia

BM - hypercellular BM, ringed sideroblasts

Question 7

Mx of MDS

Answer 7

Supportive - Transfusions of Red cells and platelets as needed, EPO, G-CSF
Immunosuppression
Allogenic BM Transplant may be required

Question 8

Causes of Megaloblastic anaemia

Answer 8

Vitamin B12 or Folate Deficiency

Question 9

Features of Magaloblastic Anaemia

Answer 9

Anaemic Features - Fatigue, Pallor etc.
Lemon Tinge - pallor + mild Jaundice
Glossitis

Neurological Features - Paraesthesia, peripheral Neuropathy, Optic Atrophy and Subacute degeneratin of the spinal cord (SACD)

Question 10

If B12 Deficieny is found what further Blod test do you want to do?

Answer 10

IF antibodies

Parietal Cell antibodies`

Question 11

Rx of Folate deficiency

Answer 11

Assess underlying cause
Unless levels are known to be normal Give B12 first
Folate 5mg/d PO

Question 12

Rx of B12 deficiency

Answer 12

Malabsorption = IM B12 - Load first (1mg/48hr IM) then maintain (1mg/3mo IM)

Dietary = Oral B12
IM B12 will reverse all neuropathies except SACD