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Haematology > Macrocytic Anaemia > Flashcards

Macrocytic Anaemia Flashcards

1
Q

Define macrocytosis:

A

An increase in abnormally large red blood cells

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2
Q

Define macrocytic anaemia:

A

Anaemia (low Hb) in which the RBCs have a larger than normal blood volume

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3
Q

What blood measurement shows macrocytosis?

A

MCV

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4
Q

Megaloblastic causes of anaemia affect what part of the cell development?

A

DNA synthesis and gene production

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5
Q

What would the blood measurements in macrocytosis look like?

A

Normal Hb
Normal RBC
High MCV

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6
Q

What would the blood measurements in macrocytic anaemia look like?

A

Low Hb

High MCV

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7
Q

On a blood film, what can be used to compare the size of RBCs?

A

A RBC should be roughly the same size as the nucleus of a lymphocyte

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8
Q

What are the two main, genuine causes of macrocytosis?

A

Megaloblastic

Non-megaloblastic

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9
Q

When do early erythrocytes lose their nuclei?

A

Once they have reached maximum Hb levels

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10
Q

What happens in ineffective erythropoiesis?

A

RBCs die prematurely in the bone marrow. The dead cells then release LDH and Hb (which is broken down into bilirubin)

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11
Q

What is a megaloblast?

A

This is an abnormally large RBC which still has a nucleus

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12
Q

What are the main causes of megaloblastic anaemia?

A

B12 deficiency
Folate deficiency
Drugs
Rare inherited conditions

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13
Q

What cycle is B12 involved in?

A

The methionine cycle

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14
Q

What important function is the folate cycle involved in?

A

Converts uridine to thymidine

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15
Q

What are B12 and Folate mainly responsible for?

A

They are important co-factors in the nuclear maturation of the erythrocyte via DNA synthesis

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16
Q

What is released from gastric parietal cells which plays an important role in the absorption of B12?

A

Intrinsic Factor

17
Q

What binds to B12 in the stomach to aid its absorption process?

A

R-protein

18
Q

Where is B12 absorbed in the GI tract?

A

Terminal end of the small bowel (i.e. ileum)

19
Q

What can cause B12 deficiency?

A 
PPIs
Bacterial overgrowth in GI tract
Poor diet
Malabsorption e.g. coeliac, IBD
Atrophic Gastritis 
Pernicious Anaemia
20
Q

Define pernicious anaemia:

A

This is an autoimmune disease which involves the destruction of gastric parietal cells, leading to decreased intrinsic factor therefore causing decreased B12 levels.

21
Q

What other diseases are associated with pernicious anaemia?

A

Hypothyroid
Addison’s
Vitiligo

22
Q

Dietary folates are converted to __________?

A

Monoglutamates

23
Q

Where are monoglutamates absorbed in the GI tract?

A

Jejunum

24
Q

What can cause a folate deficiency?

A

Decreased intake (diet)
Drugs e.g. anti-convulsant
Malabsorption
Excess utilisation of folate e.g. haemolysis, pregnancy, exfoliating dermatitis, malignancy

25
Q

List some clinical features of B12/Folate deficiency:

A 
Signs/symptoms of anaemia
Weight loss
Jaundice
Sore (beefy) tongue
Diarrhoea
Development problems
26
Q

What symptoms are specifically associated with B12 deficiency and why?

A

Neurological problems -> lack of B12 can lead to demyelination
e.g. dementia, neuropathy, psychiatric manifestations etc

27
Q

Why is jaundice seen in B12/folate deficiencies?

A

Intramedullary haemolysis

28
Q

What specific features will be seen on a blood film in B12/folate deficiency?

A

Macrocytic anaemia
Sometimes pancytopenia
Hyper segmented neutrophils

29
Q

What anti-bodies might you check for in a B12 deficiency?

A

Anti-intrinsic factor
Anti-gastric parietal cells
(to rule out pernicious anaemia)

30
Q

How do you treat pernicious anaemia

A

Regular life long Vit B12 injections

31
Q

How do you treat folate deficiency?

A

5mg folate tablets daily

32
Q

Would a patient with macrocytic anaemia ever require a blood transfusion?

A

Rarely

Only if Hb dropped so low it was absolutely necessary (e.g. below 70)

33
Q

List some causes of non-megaloblastic macrocytosis which may NOT be associated with anaemia?

A

Alcohol abuse
Liver disease
Hypothyroidism

34
Q

List some causes of non-megaloblastic macrocytosis, often associated with anaemia?

A

Marrow failure causes:

  • myelodysplasia
  • myeloma
  • aplastic anaemia
35
Q

Define spurious macrocytosis:

A

(False macrocytosis)

This is where the mature RBC count is normal BUT there is a high MCV

36
Q

What are the two main causes for spurious macrocytosis?

A 
Reticulocytosis
Cold agglutinins (clumps of RBCs)
37
Q

When does Reticulocytosis tend to occur?

A

Response to large bleeds / acute bleeds

Increased RBC breakdown

38
Q

What will be seen on a blood film of a patient with Reticulocytosis?

A

Polychromasia

Haematology (13 decks)

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