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Macrocytic anemia Flashcards

1
Q

Macrocytic Anemia

A

> 100

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2
Q

If considering macrocytic anemia, must test?

A

Vit b12

Folate

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3
Q

> 100 MCV + low b12 suspect

A

Megaloblastic anemia (pernicious anemia)
Dietary deficits
GI disease
Post-gastrectomy

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4
Q

> 100 MCV + low folate suspect

A

Megaloblastic anemia
Diet deficits
GI disease

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5
Q

> 100 MCV + NL b12/folate suspect

A

Some liver diseases
Myelodysplastic syndrome
Reticulocytosis

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6
Q

Macrocytosis and ABNL DNA metabolism causes

A 
Vb12 deficits
Folate deficits
Rx 
-hydroxyurea
-methotrexate
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7
Q

Macrocytosis and Shifts to immature/stressed RBCs causes

A

Reticulocytosis

Aplastic anemia

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8
Q

Macrocytosis and primary BM D/O causes

A

Myelodysplastic syndromes

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9
Q

Macrocytosis and ABNL lipids causes

A

Liver disease
Hypothyroidism
Hyperlipidemia

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10
Q

Macrocytosis W/ unknown mechanism of action causes?

A

Etoh abuse

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11
Q

Macrocytic anemia and smear findings

A

Hypersegmented neutrophils

Macro-ovalocytes

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12
Q

Megaloblastic anemia is

A

A macrocytic anemia that is ass/w ABNL DNA synth of RBCs 2/2 vit b12/folate deficits

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13
Q

100-105 MCV ddx

A

Hypothyroidism
Pregnancy
Chronic liver disease
Etoh Abuse

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14
Q

> 105 MCV ddx

A

Bone marrow D/O like MDS
Late megaloblastic anemia
Pernicious anemia

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15
Q

Purpose of vb12/folate?

A

Role in DNA synthesis

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16
Q

Vb12 deficits results in what concerning growth factors?

A

Abnl EPO (ineffective)

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17
Q

Vb12 is found in what foods?

A

Animal products

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18
Q

Vb12 is stored in what organ?

A

Liver

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19
Q

How long before Vb12 deficits until anemia develops?

A

> 3yr

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20
Q

Etiology of Vb12 deficits?

A

Strict vegan
Abd surgery - gastrectomy/ileum resection
IBD - severe crohns affecting ileum

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21
Q

Gastrectomy causes what to happen concerning Vb12?

A

Eliminates intrinsic factor sites of production

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22
Q

Ileum resection causes what to happen concerning Vb12?

A

Eliminates site of b12 absorption

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23
Q

Neuropsychiatric syndrome is

A

Neuro changes occurring in order over a number of years of untreated Vb12 deficits

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24
Q

Neuropsychiatric syndrome order of changes

A

1st - peripheral neuropathy
2nd - ataxia
3rd - Dementia

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25
Q

Vb12 dx criteria

A

> 100 MCV
macro-ovalocytes
Hyperseg neutrophils
<170 Vb12

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26
Q

Vb12 level ranges

A 
>300 = no deficits 
170-300 = grey-eval more
<170 = deficit
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27
Q

Vb12 indeterminate Level of 170-300 additional tests?

A 
Methymalonic acid (MMA)
Homocysteine
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28
Q

Elevated MMA+homocysteine =

A

Vb12 deficits

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29
Q

Vb12 purpose in the DNA process?

A

Cofactor that helps convert methylmalonyl-CoA to succinyl-CoA in mitichondria

30
Q

A lack of B12 during cofactor conversion leads to?

A

MMA accumulation

31
Q

Pernicious anemia is at its basic?

A

A form of Vb12 deficit

32
Q

Vb12 absorption occurs when

A

Hydrochloric acid in stomach seperates vb12 from carrier protein then combines to intrinsic factor for absorption in terminal anemia

33
Q

Pernicious anemia occurs when?

A

Anti-intrinsic factor antibodies or

Antibodies to parietal cells

34
Q

What produces intrinsic factor in the stomach?

A

Parietal cells

35
Q

Pernicious anemia etiology

A

Strong hereditary

White predominance

36
Q

Pernicious anemia dx criteria

A

Confirmed by b12 deficits
Normal folate
Pos - anti-intrinsic factor autoantibodies

37
Q

Vb12 deficit asymptomatic or peripheral neuropsthy txt

A

PO or IM b12
PO - 1000mcg/d
IM - 1000mcg/mo

38
Q

Vb12 deficits w/ pernicious anemia AND neuro dysfx TXT

A

B12 must be parenteral
IM 1000mcg/D 1st week > weekly for a month > monthly for life
AND folic acid

39
Q

Vb12 deficits w/ neuro dysfx only Txt

A

Same as pernicious anemia+neuro dysfx but switch to PO 1000mcg indefinitely only after deficit is corrected and pt is asymptomatic
AND folic acid

40
Q

After vb12 txt when does EPO and hyperseg neutrophils correct

A

EPO - w/in 1-2D

Hyperseg - disappears 10-14D

41
Q

Does folate participate in MMA metabolism?

42
Q

Folate deficit and MMA/homocysteine levels?

A

NL - MMA

elevated homocysteine

43
Q

Folate comes from what food source?

A

Plant matter

Fruit, green leafy vegs

44
Q

Folate deficit causes

A

Nutritional
Increased requirements
Malabsorptive

45
Q

Nutritional causes of folate deficits

A

(MC) Decreased diet intake

Alcoholics (dual deficiency - absorption/enterohepatic circulation ABNLs)

46
Q

Increased requirements of folate deficits

A

Physiologic - pregnancy/infancy

Pathologic - hemolytic anemia

47
Q

Malabsorptive causes of folate deficits

A

Drugs

ABNL GI conditions

48
Q

Rx that affects folate?

A 
Etoh
Methotrexate (RA, CPP)
Sulfasalazinr
Triameterene
Pyrimethamine
TMP/SMX
Phenytoin
Barbs
Topiramide
Hydroxyurea
49
Q

Folate deficit anemia starts when?

A

Weeks to Months

50
Q

Folate deficit TXT

A

PO replacement

1mg/D for 1-4mo until hematologic recovery

51
Q

Megaloblastic anemia (b12 and/or folate deficit) clinical features - HEMATOLOGIC

A

Macrocytic anemia; pancytopenia w/ megaloblastic BM

52
Q

Megaloblastic anemia (b12 and/or folate deficit) clinical features - CARDIOPULM

53
Q

Megaloblastic anemia (b12 and/or folate deficit) clinical features - GI

A

Macroglossitis

Malabsorption syndromes

54
Q

Megaloblastic anemia (b12 and/or folate deficit) clinical features - DERMATOLOGIC

A

Melanin pigmentations

Prematuring graying

55
Q

Megaloblastic anemia (b12 and/or folate deficit) clinical features - GENITAL

A

Cervical

Uterine dysplasia

56
Q

Megaloblastic anemia (b12 and/or folate deficit) clinical features - REPRODUCTIVE

A

Infertility

Sterility

57
Q

Megaloblastic anemia (b12 and/or folate deficit) clinical features PSYCHIATRIC

A

Depressed affect

Cognitive dysfx

58
Q

Megaloblastic anemia (b12 ONLY) clinical features NEUROPSYCHIATRIC

A 
Disrupted proprioception
Neuropathic pain
Paresthesia
—req tuning fork
—applies to B12 only
59
Q

Megaloblastic anemia W/U

A 
Direct B12 - folate
B12 deficit 
-- <170
--macro-ovalocytes 
—hypersegs
—^MMA/homocysteine 
Homocysteine level
—^ both b12/folate
MMA
--^b12 only
Folic acid deficit
--<150
— macro-ovalocytes
—hypersegs
—NL MMA
—^homocysteine
60
Q

Other causes Macrocytic anemia

A 
Chronic liver disease
Etoh use D/O
Myelodysplastic syndrome
Hypothyroidism
Pregnancy
61
Q

Alcoholic use D/O effects what?

A
  1. Direct bone marrow toxicity

2. Interferes w/ folate metabolism

62
Q

If a pt w/ alcoholic use D/O abstains then what happens to the macrocytosis?

A

resolves w/in 2-4mo if irreversible liver damage has not occured

63
Q

Myelodysplastic syndromes are essentially?

A

A pre-leukemic process

64
Q

BM D/O w/ ineffective erythropoiesis and dysplasia are due to?

A

Mutation in a hematopoietic stem cell

65
Q

Peak MDS age pop?

66
Q

What is the etiology of MDS?

A 
Idiopathic 80%
2/2
-Chemo
-Radiation
-Toxic substances (benzene)
67
Q

MDS MCV?

68
Q

MDS can lead to what blood cancer?

69
Q

MDS clinical findings are

A

Anemia - fatigue, pallor
Neutropenia (Leukopenia) - (Inf risks, fever)
Thrombocytopenia - (Bleeding)
+-splenomegaly

70
Q

MDS CBC criteria?

A

Leukopenia
Anemia
Thrombocytopenia
=Pancytopenia

71
Q

MDS TXT

A 
Supportive
Transfusions 
<7hgb = pRBCs
<50k plt and surgery consideration = PLT's
<20k plt and bleeding = PLT's
<10k plt and asymptomatic
-refer heme/onc or send to ED
72
Q

Other Macrocytic anemia etiologies?

A
  1. Hypothyroidism > levothyroxine > failure think pernicious anemia (both autoimmune dz)
  2. Pregnancy - increased folate requirements
    - txt w/ folic acid supplement to pvt NTD

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