Megaloblastic Anaemia

Question 1

Blood Film (7)

Answer 1

Oval Macrocytes

Schistocytes

Pancytopenia (all types of cells)

LargerRBC

Howell-Jolly Bodies

Megaokaryocytes (granular nuclear)

Hyper-segmented Neutrophils (6+ lobes)

Question 2

Other Tests

Answer 2

ELISA for Pernicious Anaemia

Question 3

Symptoms Of Megaloblastic Anaemia

Answer 3

Sclera of eye

Glossitis (tongue)

Jaundice (from increased RBC breakdown+bilirubin)

Question 4

Treatment of B12

Answer 4

6 x 1000ug 2-3wks

maintenance dose 1000ug/3months

60days to reach normal Hb levels

Question 5

Treatment of Folate

Answer 5

5mg B12 helps for 4 months

Takes 2 days for improvement

Question 6

What does a lack of B12 cause (pathology)

Answer 6

No conversion of:

Homocysteine –> methionine

Methylmalonyl-CoA –> Succinyl-CoA

Responsible for serotonin/dopamine production

Question 7

Perniscious Anaemia is caused by what

Answer 7

Lack of IF to absorb B12

Question 8

Common Causes of B12

Answer 8

Inadequate intake (beef/eggs)

Pernicious anaemia

min (1-2mcg.day)
Need (7-30mcg/day)

Question 9

Common Causes Of Folate

Answer 9

Inadequate intake (greens)

need (400ug/day)

Impaired utilisation caused by drugs (aminopterin) affecting drug metabolism

Excessive loss from skin

Renal abnormalities (CKD/AKD)