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haematology > macrocytosis andmacrocytic anaemia > Flashcards

macrocytosis andmacrocytic anaemia Flashcards

1
Q

macrocytosis?

A

big cells, increase in number of cells

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2
Q

macrocytic anaemia

A

anaemia in which red cells have a larger than normal volume

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3
Q

units of MCV?

A

femtolitres

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4
Q

normal MCV?

A

80-100

over 100 is macrocytic

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5
Q

blast =

A

with a nucleus

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6
Q

what is a megalosbast?

A

abnormally large nucleated red cell precurosor with an immature nucleus

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7
Q

megaloblastic anaemias are characterised by predominent defects in ?

A

DNA synthesis and nuclear maturation, with relative preservation of RNA and haemoglobin synthesis

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8
Q

preservation of ?

A

RNA and haemoglobin synthesis

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9
Q

while cytoplasm has developed and become mature (big enough to divide), the nucleus is still immature and lagging behind

A

leads to bigger than normal red precursor

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10
Q

cell can sense it has enough haemoglobin and doesnt need to divide anymore

A

end result = microcytic cells

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11
Q

larger cell in megaloblastic anarmia due to?

A

a failure to become smaller, not an increase in cell size

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12
Q

causes of megaloblastic anaemia

A

b12 deficiency
folate deficiency
others - drugs or rare inherited anomalies

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13
Q

what are b12 and folate essential co factors for?

A

nuclear maturation

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14
Q

what do they enable?

A

chemical reactions that provide enough nucleosides for DNA SYNTHESIS

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15
Q

2 cycles ?

A

methionine and folate cycle

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16
Q

b12 and folate biochemical reactions are interlinked .

A

what does the methionine cycle produce?

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17
Q

s-adenosyl methionine

A

y

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18
Q

what is s-adenosyl methionine?

A

a methyl donor to DNA and folate intermediates

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19
Q

folate cycle important for nucleoside synthesis

A

eg uridine to thymidine conversion

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20
Q

what is b12 bound to in the stomach ?

A

haptocorrin

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21
Q

ditches haptocorrin and binds with ?

A

IF

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22
Q

absorbed across which receptors?

A

cubulin

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23
Q

where is b12 absorbed?

A

ileum

24
Q

dietary folates converted into?

A

monoglutamate

25
Q

where is folate absorbed?

A

jejunum

26
Q

where do you get vitamin b12 from?

A

animal

27
Q

folate?

A

leafy geren veg - destroyed by cooking

28
Q

how long does body store vitamin b12?

A

2-4 years

29
Q

folate?

A

4 months

30
Q

B12 ilium

A

bilium

31
Q

Folate at Duodenum and Jejunm

A

.

32
Q

causes of folate deficiency?

A

dietary causes more likely than b12 due to lesser stores. malabsorption (coeliac, crohns)

33
Q

when can you get excess utilisation of folate?

A

haemolysis, exfoliating dermatitis, pregnancy, malignancy

34
Q

which type of drugs cause folate deficiency?

A

anti convulsants

35
Q

clinical features of B12 and folate deficiency?

A

symptoms/signs of anaemia, weight loss, diarrhoea, sore tongue, jaundice

36
Q

if you have vitamin b 12 problems only, can get neurologica problems i.e. neuropathy, dementia, psychiatric manifestations

A

y

37
Q

autoimmune condition resulting in destruction of gastric parietal cells?

A

pernicious anaemia

38
Q

associated with atrophic gastritis and personal or family history of other autoimmune disorders

A

eg hypothyroidism, addisons

39
Q

perniciooud anaemia also known as ?

A

b12 defiency anaemia

40
Q

why do you get a shortage of b12?

A

autoimmune attack against gastric parietal cells, which produce intrinsic factor

41
Q

what would blood film show?

A

macrovalocytes and hypersegmented neutrophils (usually 3-5 nuclear segments)

42
Q

pancytopaenia in some patients

A

y

43
Q

diagnosis…?

A

anti GPC (gastric parietal cell) and anti intrinsic factor (anti IF)

44
Q

which one is sensitive and non specific?

A

ant GPC

45
Q

which one is specific and non sensitive?

A

anti IF

46
Q

can also do?

A

assay b12 and folate levels in serum

47
Q

treatment of megaloblastic anaemia?

A

treat the cause

folic acid tablets orally

48
Q

treatment for p anemia?

A

b12 injections for life

49
Q

causes of non megaloblastic macrocytosis? (big cells, increased number)

A

LAHM - liver disease, alcohol, hypothyroidism, marrow failuer

50
Q

spurrious macrocytosis

A

reticulocytes bigger than mature red blood cells

51
Q

what does reticulocytosis indicate?

A

marrow response to loss of red cells either through acute bleeding or haemolysis

52
Q

in cold agglutinated disease, what happens?

A

analyser gets confused as clumps of agglutinated red cells go through and are registered as 1 big cell

53
Q

why can patients with pernicious anaemia appear mildly jaundiced?

A

due to intramedullary haemolysis

54
Q

why do you get jaundice in pernicious anaemia?

A

defective red cells broken down. ham converted to bilirubin

55
Q

can get pancytopenia due to b12 folate deficiency

A

nuclear maturation defects can affect all lineages

haematology (20 decks)

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