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Clinical Medicine 1 > Macrocytic Anemias > Flashcards

Macrocytic Anemias Flashcards

1
Q

Macrocytic vs Megaloblastic

A

Macrocytic >100-115

Megaloblastic >115

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2
Q

2 Megaloblastic Anemias?

A

B12 deficiency

Folic Acid Deficiency

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3
Q

Common Macrocytic Anemias?

A

Reticulocytosis, liver dz, alcoholism, hypothyroid, aplastic anemia, meds

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4
Q

What is left over in Reticulocytosis?

A

RNA left over in reticulocytes

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5
Q

When will an alcoholic macrocytic anemia return to normal?

A

2-4 months after drinking cessation

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6
Q

Combo antiretroviral therapy causes what type of anemia?

A

Macrocytic Anemia

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7
Q

Who gets Aplastic Anemia? What ages?

A

East Asian.

Biphasic age distro: 10-25, 60+

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8
Q

Aplastic Anemia is due to injury to what type of cell?

A

Pluripotent Stem Cell

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9
Q

Aplastic Anemia does what to all 3 major blood lines?

A

Reduces their numbers.

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10
Q

Do the cells look normal in Aplastic Anemia?

A

Yes they look normal, just not a lot of cells

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11
Q

What type of failure is Aplastic Anemia?

A

Bone Marrow failure

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12
Q

What is Fanconi Anemia?

A

DNA repair defect that can cause Aplastic Anemia

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13
Q

What is Dyskeratosis Congenita?

A

Defect in maintenance of hematopoietic stem cell telomere length maintenance. Cause of Aplastic Anemia.

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14
Q

Inciting Event of Aplastic Anemia?

A

Exposure which kills the hemipoietic stem cells. Takes weeks to months until pancytopenic effect is seen. WBCs die first so see infection first.

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15
Q

What seen first in Aplastic Anemia?

A

Infection due to WBCs dying off

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16
Q

Recurrent infections in Aplastic Anemia due to what?

A

Profound neutropenia

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17
Q

Mucosal Hemorrhage in Aplastic Anemia due to what?

A

Thrombocytopenia

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18
Q

Aplastic Anemia can cause what to increase in premenopausal women?

A

Increased menstural flow

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19
Q

Two most common PE findings in Aplastic Anemia?

A

Pallor and Petechiae

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20
Q

What does CBC show in Aplastic Anemia?

A

Pancytopenia. All cell lines low.

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21
Q

Reticulocyte Index high or low in Aplastic Anemia?

A

Low

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22
Q

Are cells in Aplasic Anemia normal or abnormal?

A

Normal. Just low in number.

23
Q

Tx for Aplastic Anemia if under 20 y/o?

A

Allogenic hematopoietic stem cell transplant (HCT) unless can’t get for a really good reason then use Immunosuppressive Therapy (IST)

24
Q

Tx for APlastic Anemia is over 50 y/o?

A

Allogenic hematopoietic stem cell transplant (HCT) can be considered but immunosuppressive therapy is better as it disrupts the process which kills the stems cells

25
Q

What is the most common form of congenital Aplastic Anemia?

A

Fanconi Amenia

26
Q

Etiology of Fanconi Anemia? (hint: genetic)

A

Autosomal recessive disorder causing defect in DNA repair pathway

27
Q

What is Sindactyly and seen where?

A

Fused digits seen in Fanconi Anemia

28
Q

TOC for Fanconi Anemia?

A

Allogeneic hematopoietic cell transplantation (HCT). Can

restore normal hematopoiesis.

29
Q

VitB12 and Folate deficiencies what type of cytic anemia?

A

Megaloblastic Anemia. MCV >110-115

30
Q

Which megaloblastic anemia causes neurological problems?

A

VitB12

31
Q

Segmented Neutrophils seen in what type of anemia?

A

Megaloblastic

32
Q

2 main causes of Megaloblastic Anemia?

A

Vegans who don’t get enough B12

Folate stores reduce in preggers and alcoholics

33
Q

How much B12 is needed in a day?

A

3-5mcg

34
Q

What absorbs VitB12?

A

Intrinsic Factor

35
Q

Which cell makes Intrinsic Factor?

A

Parietal Cells in stomach

36
Q

Which part of intestine is B12-IF complex absorbed in?

A

Terminal Ileum

37
Q

B12 super important for metabolism of _____ and synthesis of ____

A

Nucleic acid metabolism

Myelin synthesis

38
Q

Etiology of Pernicious Anemia?

A

Autoimmune dz destroys parietal cells and no Intrinsic Factor

39
Q

Neurologic sx of Pernicious Anemia

A

Due to B12 deficiency. Peripheral nerves affected first. Balance and propioception, altered cerebral function.

40
Q

Decreased sense of vibration, decreased positional sense, and memory disturbances due to what?

A

Vit B12 deficiency

41
Q

Serum B12 level in B12 Deficiency?

A

<170

42
Q

Does Pancytopenia occur with B12 deficiency?

A

Yes!

43
Q

Tx for B12 deficiency?

A

Vitamin B12 100mcg SC or IM - daily x 1 week, then weekly x 1 month, then monthly for life

44
Q

Folic Acid is critial in the synthesis of what?

A

DNA synthesis

45
Q

Most common cause of Folic Acid Deficiency?

A

Inadequate intake

46
Q

Folic Acid found in what foods?

A

Fruits and veggies

47
Q

Can alcoholism cause Folic Acid Deficiency?

A

Yes!

48
Q

Does Folic Acid Deficiency have neurological sx?

A

NO

49
Q

RBC folic acid level below what in Folic Acid Deficiency?

A

<150

50
Q

Tx for Folic Acid Deficiency?

A

Folic acid 1 mg PO daily for 1-4 months or hematologic recovery

51
Q

What else to check in suspected Folic Acid Deficiency?

A

Check for concomitant B12 deficiency

52
Q

Where is Folic Acid absorbed?

A

Throughout GI tract (duodenum and jejunum)

53
Q

Body stores of B12 last how long? Folate?

A

B12=3 years

Folate=2-3 months

54
Q

Positive Schilling Test in which megaloblastic anemia?

A

Pernicious Anemia

Clinical Medicine 1 (8 decks)

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