Macrocytic Anemia

Question 1

What is the major difference between megaloblastic and nonmegaloblastic macrocytic anemia

Answer 1

-in megaloblastic, hypersegmented neurophil is present

Question 2

What is the drug that may lead to folate megaloblastic anemia

Answer 2

-phenytoin (it inhibits conjugase enzyme that is responsible to absorption of folate in jejunum)

-alcohol (decrease the folate absorption in the jejunum)

Question 3

What are the causes of folate deficiency macrocytic anemia

Answer 3

-decrease supply (malnutrition, malabsorption; alcoholism and celiac disease)
-increase demand (pregnancy, hemolytic anemia
-drugs (phenytoin, MTX, TMP-SMX)

Question 4

From the symptoms, what will differ folate anemia and B12 anemia

Answer 4

-b12 anemia typically presents with neurological symptoms but folate anemia does not present with the symptoms

Question 5

What happens to homocysteine level in megaloblastic anemia

Answer 5

-increase

Question 6

What are the causes of B12 deficiency anemia

Answer 6

-pernicious anemia
-malnutrition (veganism)
-stomach damage (gastrectomy)
-pancrease damage (pancreatic insufficiency)
-illeum damage (crohn’s disease, diphyllobothrium latum)

Question 7

What is the B12 related symptoms

Answer 7

-neurological
-lemon yellow skin
-glossitis

Question 8

What are the affected area neurological symptom of subacute combined degeneration

Answer 8

-dorsal column: loss of vibration sensation
-lateral corticospinal tract: weakness
-spinocerebellar tract: ataxia

Question 9

What the specific lab test that increase in B12 deficiency

Answer 9

-serum methylmalonic acid

Question 10

Why folate supplementation cannot be given alone in B12 deficiency disease

Answer 10

-because it only treats anemia but it worsens the neurological symptoms