Macrocytic Anaemia

Question 1

What is a megaloblast?

Answer 1

Cell in which nuclear maturation is delayed compared with the cytoplasm due to delayed DNA synthesis

Question 2

What find on a blood film for B12/ folate deficiency?

Answer 2

Macrocytic anaemia

HYPERSEGMENTED NEUTROPHILS

Target cells if liver disease

Question 3

What foods folate in?

Answer 3

Offal
Green vegetables
Nuts
Yeast

Body can store for 4 months
Absorbed by duodenum/proximal jejunum

Question 4

What drugs cause folate deficiency?

Answer 4

Anti epileptics (phenytoin, valproate)
Methotrexate
Trimethoprim
Sulfasalazine

Question 5

How treat folate deficiency?

Answer 5

Assess for underlying cause

Give folic acid 5mg/day for 4 months
Never give without B12 unless sure pt has normal B12 level (prevent subacute combined degeneration of spinal cord)

Question 6

Where is B12 absorbed in body? How long stored for?

Answer 6

Terminal ileum

4 years

Question 7

Specific features of B12 deficiency?

Answer 7

Lemon tinge skin
Glossitis (big beefy red sore tongue)
Angular cheilosis

Neuropsychiatric:
Irritability
Depression 
Psychosis
Visual disturbances 
Dementia

Neurological:
Peripheral neuropathy
Parasthesiae
SUBACUTE COMBINED DEGENERATION OF SPINAL CORD

Question 8

Classic triad of a patient with subacute degeneration of spinal cord?

Answer 8

Extensor planters (UMN)
Absent knee reflexes (LMN)
Absent ankle jerk (LMN)

Question 9

Management of B12 deficiency?

Answer 9

1mg IM hydroxycobalamin:

3 times each week for 2 weeks
Then once every 3 months

Treat B12 before folic acid if also folic acid deficienct