Macrocytic Anemia

Question 1

Approach to macrocytic anemia?

Answer 1

Peripheral blood film

Oval RBCs = megaloblastic
Round RBCs = non-megaloblastic

Question 2

Ddx for megaloblastic macrocytic anemia?

Answer 2

B12 deficiency
Folate deficiency
Drugs (hydroxyurea, MTX)

All impair DNA synthesis

Question 3

Ddx for non-megaloblastic macrocytic anemia?

Answer 3

Chronic liver disease
Chronic renal disease
Alcoholism

Question 4

What are hypersegmented neutrophils suggestive of?

Answer 4

Vitamin B12 or folate defifiency megaloblastic macrocytic anemia

Question 5

What is pernicious anemia?

Answer 5

Antibodies to gatric parietal cells, where intrinsic factor is made, which is required for B12 absorption

Question 6

What are the causes of low vitamin B12?

Answer 6

Usually malabsorption

IBD (terminal ileum where B12 absorption occurs is affected) or pernicious anemia

Question 7

Treatment of B12 deficiency megaloblastic macrocytic anemia?

Answer 7

Oral vitamin B12 supplementation, even if pernicious anemia is cause