Macrocytic Anemias Flashcards
Macrocytic vs Megaloblastic
Macrocytic >100-115
Megaloblastic >115
2 Megaloblastic Anemias?
B12 deficiency
Folic Acid Deficiency
Common Macrocytic Anemias?
Reticulocytosis, liver dz, alcoholism, hypothyroid, aplastic anemia, meds
What is left over in Reticulocytosis?
RNA left over in reticulocytes
When will an alcoholic macrocytic anemia return to normal?
2-4 months after drinking cessation
Combo antiretroviral therapy causes what type of anemia?
Macrocytic Anemia
Who gets Aplastic Anemia? What ages?
East Asian.
Biphasic age distro: 10-25, 60+
Aplastic Anemia is due to injury to what type of cell?
Pluripotent Stem Cell
Aplastic Anemia does what to all 3 major blood lines?
Reduces their numbers.
Do the cells look normal in Aplastic Anemia?
Yes they look normal, just not a lot of cells
What type of failure is Aplastic Anemia?
Bone Marrow failure
What is Fanconi Anemia?
DNA repair defect that can cause Aplastic Anemia
What is Dyskeratosis Congenita?
Defect in maintenance of hematopoietic stem cell telomere length maintenance. Cause of Aplastic Anemia.
Inciting Event of Aplastic Anemia?
Exposure which kills the hemipoietic stem cells. Takes weeks to months until pancytopenic effect is seen. WBCs die first so see infection first.
What seen first in Aplastic Anemia?
Infection due to WBCs dying off
Recurrent infections in Aplastic Anemia due to what?
Profound neutropenia
Mucosal Hemorrhage in Aplastic Anemia due to what?
Thrombocytopenia
Aplastic Anemia can cause what to increase in premenopausal women?
Increased menstural flow
Two most common PE findings in Aplastic Anemia?
Pallor and Petechiae
What does CBC show in Aplastic Anemia?
Pancytopenia. All cell lines low.
Reticulocyte Index high or low in Aplastic Anemia?
Low
Are cells in Aplasic Anemia normal or abnormal?
Normal. Just low in number.
Tx for Aplastic Anemia if under 20 y/o?
Allogenic hematopoietic stem cell transplant (HCT) unless can’t get for a really good reason then use Immunosuppressive Therapy (IST)
Tx for APlastic Anemia is over 50 y/o?
Allogenic hematopoietic stem cell transplant (HCT) can be considered but immunosuppressive therapy is better as it disrupts the process which kills the stems cells
What is the most common form of congenital Aplastic Anemia?
Fanconi Amenia
Etiology of Fanconi Anemia? (hint: genetic)
Autosomal recessive disorder causing defect in DNA repair pathway
What is Sindactyly and seen where?
Fused digits seen in Fanconi Anemia
TOC for Fanconi Anemia?
Allogeneic hematopoietic cell transplantation (HCT). Can
restore normal hematopoiesis.
VitB12 and Folate deficiencies what type of cytic anemia?
Megaloblastic Anemia. MCV >110-115
Which megaloblastic anemia causes neurological problems?
VitB12
Segmented Neutrophils seen in what type of anemia?
Megaloblastic
2 main causes of Megaloblastic Anemia?
Vegans who don’t get enough B12
Folate stores reduce in preggers and alcoholics
How much B12 is needed in a day?
3-5mcg
What absorbs VitB12?
Intrinsic Factor
Which cell makes Intrinsic Factor?
Parietal Cells in stomach
Which part of intestine is B12-IF complex absorbed in?
Terminal Ileum
B12 super important for metabolism of _____ and synthesis of ____
Nucleic acid metabolism
Myelin synthesis
Etiology of Pernicious Anemia?
Autoimmune dz destroys parietal cells and no Intrinsic Factor
Neurologic sx of Pernicious Anemia
Due to B12 deficiency. Peripheral nerves affected first. Balance and propioception, altered cerebral function.
Decreased sense of vibration, decreased positional sense, and memory disturbances due to what?
Vit B12 deficiency
Serum B12 level in B12 Deficiency?
<170
Does Pancytopenia occur with B12 deficiency?
Yes!
Tx for B12 deficiency?
Vitamin B12 100mcg SC or IM - daily x 1 week, then weekly x 1 month, then monthly for life
Folic Acid is critial in the synthesis of what?
DNA synthesis
Most common cause of Folic Acid Deficiency?
Inadequate intake
Folic Acid found in what foods?
Fruits and veggies
Can alcoholism cause Folic Acid Deficiency?
Yes!
Does Folic Acid Deficiency have neurological sx?
NO
RBC folic acid level below what in Folic Acid Deficiency?
<150
Tx for Folic Acid Deficiency?
Folic acid 1 mg PO daily for 1-4 months or hematologic recovery
What else to check in suspected Folic Acid Deficiency?
Check for concomitant B12 deficiency
Where is Folic Acid absorbed?
Throughout GI tract (duodenum and jejunum)
Body stores of B12 last how long? Folate?
B12=3 years
Folate=2-3 months
Positive Schilling Test in which megaloblastic anemia?
Pernicious Anemia