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Haematology > Macrocytic Anaemia > Flashcards

Macrocytic Anaemia Flashcards

1
Q

Define Macrocytic Anaemia?

A

Anaemia associated with a high MCV of erythrocytes (> 100 fl in adults)

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2
Q

What are the two main types of Macrocytic Anaemia?

A

Megaloblastic

Non-Megaloblastic

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3
Q

What is Megaloblastic Macrocytic Anaemia?

A

When the bone marrow produces unusuually large, structurally abnormal, immature red cells

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4
Q

What is the aetiology of Megaloblastic Macrocytic Anaemia?

A

Caused by deficiency of B12 or Folate required for the conversion fo deoxyuridate to thymidylate, DNA synthesis and nuclear maturation

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5
Q

What are the causes of Vitamin B12 deficiency?

A 
Reduced absorption (e.g. post-gastrectomy, pernicious anaemia, terminal ileal resection or disease)
Reduced intake (vegans)
Abnormal metabolism (congenital transcobalamin II deficiency)
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6
Q

What are the causes of Folate Deficiency?

A

Reduced intake (alcoholics, elderly, anorexia)
Increased demand (pregnancy, lactation, malignancy, chronic inflammation)
Reduced absorption
Jejunal disease (e.g. coeliac disease)
Drugs (e.g. phenytoin)

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7
Q

What drugs can cause Megaloblastic Macrocytic Anaemia?

A

Methotrexate (dihyrdofolate reductase inhibitor)
Hydroxyurea
Azathioprine
Zidovudine

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8
Q

What are the causes of Non-Megaloblastic Macrocytic Anaemia?

A 
Alcohol excess 
Liver disease 
Myelodysplasia 
Multiple Myeloma 
Hypothyroidism 
Haemolysis (shift to immature red cell form - reticulocytosis)
Drugs (e.g. tyrosine kinase inhibitor)
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9
Q

What is the epidemiology of Macrocytic Anaemia?

A

More common in ELDERLY FEMALES

Pernicious anaemia is the MOST COMMON cause of B12 deficiency in the West

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10
Q

What are the presenting symptoms of Macrocytic Anaemia?

A

Non-specific symptoms of anaemia
Family history of autoimmune disease
Previous GI surgery
Symptoms of the CAUSE (e.g. weight loss, diarrhoea)

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11
Q

What are the Non-specific symptoms of Anaemia?

A

Tiredness
Lethargy
Dyspnoea

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12
Q

What are the various groups of signs for Macrocytic Anaemia on physical examination?

A

Signs of Anaemia
Signs of Pernicious Anaemia
Signs of B12 deficiency

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13
Q

What are the Signs of Anaemia for Macrocytic Anaemia on physical examination?

A

Pallor
Tachycardia
Breathlessness

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14
Q

What are the Signs of Pernicious Anaemia for Macrocytic Anaemia?

A

Mild jaundice
Glossitis
Angular Stomatitis
Weight Loss

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15
Q

What are the signs of B12 deficiency for Macrocytic Anaemia on physical examination?

A 
Peripheral neuropathy
Ataxia 
Subacute combined degeneration of the spinal cord 
Optic atrophy 
Dementia
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16
Q

What investigations do we do for Macrocytic Anaemia?

A 
Bloods 
Blood Film
Schilling Test 
Bone Marrow Biopsy (rarely needed)
Investigations for the cause
17
Q

What bloods do we do for Macrocytic Anaemia?

A 
FBC 
LFT 
ESR 
TFT 
Serum Vitamin B12 
Red cell folate 
Anti-parietal cell and anti-intrinsic factor antibodies 
Serum protein electrophoresis
18
Q

What do we look for on a FBC for Macrocytic Anaemia?

A

High MCV
Pancytopaenia in megaloblastic anaemia
Different degrees of cytopaenia in myelodysplasia
Exclude reticulocytosis

19
Q

What do we look for on LFT for Macrocytic Anaemia?

A

High bilirubin (due to ineffective erythropoiesis or haemolysis)

20
Q

What are we looking for in Serum Protein Electrophoresis for Macrocytic Anaemia?

A

Looking for a dense band in myeloma

21
Q

What do we see on a Blood Film for Macrocytic Anaemia?

A

Large erythrocytes

22
Q

What do we see on a Blood Film for Megaloblastic Anaemia?

A

Megaloblasts

Hypersegmented neutrophil nuclei

23
Q

What is the Schilling Test?

A

Method of testing for pernicious anaemia

B12 will only be absorbed when given with intrinsic factor

24
Q

What is the management plan for Pernicious Anaemia-related Macrocytic Anaemia?

A

IM hydroxycobalamin for life

25
Q

What is the management plan for Folate Deficiency-related Macrocytic Anaemia?

A

Oral folic acid

If B12 deficiency is present, it must be treated before the folic acid deficiency

26
Q

What are the possible complications of Macrocytic Anaemia?

A

Pernicious Anaemia leads to increased risk of gastric cancer
Pregnancy - folate deficiency increases the risk of neural tube defects

27
Q

What is the prognosis for patients with Macrocytic Anaemia?

A

Majority are treatable if there are no complications

Haematology (24 decks)

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