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Blood > Macrocytic Anemia 9/27 > Flashcards

Macrocytic Anemia 9/27 Flashcards

1
Q

What tests are done if MCV is low?

A

Iron studies

Hgb electrophoresis

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2
Q

What tests do you run if MCV is normal?

A

Check serum creatine and TSH

Bone marrow exam

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3
Q

What do you do if MCV is high?

A

Check folate and B12 levels

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4
Q

What molecules are required for RBC synthesis? (7)

A
  1. EPO
  2. Proteins for globins
  3. Iron
  4. B12 & B6
  5. Vitamin C
  6. Folic acid
  7. TH, estrogen, androgen
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5
Q

In macrocyctic anemia, what will the values of MCH and MCHC be compared to normal?

A

MCH: ⬆️
MCHC: normal (conc of Hgb is normal)

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6
Q

What is the MCV megaloblastic Macrocytic anemia?

A

MCV > 110

Severe

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7
Q

What is the MCV of non-megaloblastic?

A

MCV: 100-110

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8
Q

What are the causes of megaloblastic anemia? (3)

A
  1. B12 deficiency
  2. Folate deficiency
  3. Drugs
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9
Q

What are the causes on non-megaloblastic anemia? (6)

A
  1. Alcoholism
  2. Liver disease
  3. Hypothyroidism
  4. Aplastic anemia
  5. Hemolysis/acute bleed
  6. Artifact
    • cold agglutin disease
    • hyperglycemia (RBC swelling)
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10
Q

What is the shape of RBCs in Macrocytic anemia?

A

Oval: macro ovalocytes

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11
Q

What is the RBC shape in non-megaloblastic anemia?

A

ROUND

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12
Q

What part of the cell cycle are B12 and folic acid required for?

A

DNA synthesis

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13
Q

What is the term for when B12/folic acid deficiency impairs nuclear maturation?

A

Nuclear cytoplasmic asynchrony: abnormally large erythroid precursors and RBCs

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14
Q

Where is folic acid absorbed and what does it bind to for transportation?

A

Duodenum & Jejunum

Transported by albumin

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15
Q

What is the metabolic function of folic acid? (2)

A
  1. Purine synthesis

2. Conversion of homocysteine to methionine (also requires b12)

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16
Q

Four causes of folic acid deficiency:

A
  1. Increased demand: pregnancy, lactation, puberty
  2. Decreased intake: elderly, low socioeconomic status, alcoholics
  3. Decreased absorption: acidic foods, drugs (BC, phenytoin), celiac disease, heat
  4. Metabolic inhibition
17
Q

How is B12 absorbed?

A

B12 binds with intrinsic factor (IF), which is synthesized in gastric cells.

Absorption occurs in distal ileum.

18
Q

What is the name of the protein that transports B12?

A

TRANSCOBALAMINE II: synthesized in liver, carries b12 to liver, nerves, bone marrow

19
Q

What could cause impaired absorption of B12? (5)

A
  1. IF deficiency due to chronic gastritis
  2. Malabsorption states
  3. Intestinal disease (lymphoma, sclerosis)
  4. Parasite - tapeworm
  5. Bacterial overgrowth
20
Q

What folate dependent reaction leads to defective DNA synthesis?

A

Thymidylate synthesis

21
Q

What 2 enzymatic reactions is B12 a necessary cofactor for?

A
  1. Homocysteine to methionine
  2. Methylmalonyl CoA to succinyl-CoA
    - –> NEUROLOGICAL DEFICIENCIES
22
Q

What does the stomach secrete to metabolize B12?

A

Trypsin and stomach acids release B12. IF is released. B12 binds to R-Binding Protein

23
Q

What happens to B12 in the Jejunum?

A

PEPSIN releases B12 from R-binding protein.

B12 binds to IF and is carried to ileum, which is where it is absorbed.

24
Q

How long does it take folate deficiency to develop into megaloblastic anemia? How long for B12?

A

Folate: 4 months

B12: ~3-5 years

25
Q

PERNICIOUS ANEMIA is an impaired absorption of B12 leading to deficiency? How?

A

Decreased secretion of intrinsic factor due to gastric atrophy, loss of parietal cells.

26
Q

What are 5 other causes of impaired absorption of B12?

A
  1. Chronic pancreatitis
  2. Chron’s disease
  3. Ileal Sprue
  4. Fish tapeworm
  5. Blind loop (intestinal bacterial overgrowth)
27
Q

How are the levels of methylmalonic acid and homocysteine affected with B12 deficiency? Folate deficiency?

A

B12: both increased

Folate: only homocysteine increased

28
Q

What test should be performed to determine the source of B12 deficiency?

A

Schillings Test

29
Q

What are the sequence of changes in megaloblastic anemia? (5)

A
  1. Vitamin levels ⬇️
  2. Neutrophil hypersegmentation
  3. Ovalocytes
  4. Megaloblastic changes in BM
  5. Anemia

Blood (13 decks)

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