Module 6 Megaloblastic and non megaloblastic anemia

Question 1

b12 and folate deficiency type

Answer 1

megaloblastic

Question 2

chronic liver disease, alcoholism, endocrine disorders

Answer 2

macrocytic normoblastic

Question 3

proliferation defects

Answer 3

aplastic anemia, pure red cell anemia, Anemia chronic renal disease.

Question 4

folate deficiency causes and related syndromes

Answer 4

nutritional deficiency increased requirement, malabsorption drug innhibition

Question 5

b12 deficiency

Answer 5

pernicious anemia, small bowell resection, gastrectomy, malabsorption, nutritional deficiency,

Question 6

normoblastic macrocytic anemia causes

Answer 6

alcohol, liver disease, hypothyroidism, aplatic anemia. Can be artifactual caused by cold aglutinins, hyperglycemia.

Question 7

IF

Answer 7

required for b12 absorption. Hampered in pernicious anemia.

Question 8

transcobalamin

Answer 8

transports b12 in circulation, lack of this protein leads to a deficiency.

Question 9

HGB, AND HCT

Answer 9

decreased macrocytic anemia (>100fL)

Question 10

reticulocyte increased in macrocytic anemia

Answer 10

likely hemolytic anemia.

Question 11

blood smear of megaloblastic anemia

Answer 11

macro ovalocytes, dacrocytes, howell jolly bodies, hypersegmentation. Do serum b12 assay.

Question 12

Folic acid structure

Answer 12

pteridine ring, PABA, glutamatic acid

Question 13

causes folic acid deficiency

Answer 13

inadequate diet, increased requirement: pregnancy, infancy sickle cell anemia, thalassemia, leukemia; malabsorption tropical and non tropical sprue; Drug inhhibition; bacterial overgrowth in small intestine.

Question 14

tropical sprue

Answer 14

flattening villie, malabsorption of folate B12.

Question 15

folate use

Answer 15

donate methyl groups for Nucleic acid synthesis

Question 16

B12 structure

Answer 16

cobalt atom chelated in middle of chorin ring. cobalamin.

Question 17

B12 absorption

Answer 17

Rbinder protein binds cobalamin and protects in stomach. rprotein degraded by pangreatic enzymes. Binds IF the IF receptor gets absorbed.

Question 18

Pernicious Anemia

Answer 18

no IF, no absorption

Question 19

Pancreatic insufficiency

Answer 19

pancreatic enzymes do not produce sufficient to destroy R binder protein, therefore no absorption.

Question 20

Transcobalamin 2

Answer 20

B12 transporter. Inadequate TC2 means no less transport, mitotically active cells hampered.

Question 21

Causes B12 deficiency

Answer 21

Absorption: sprue, gastrectomy, Celiac, Pernicious anemia; Biological competition

Question 22

Schilling test part 1

Answer 22

Give oral dose radiolabeled B12, flush large non radio labeled. 24 hour urine collection, normal if > 7.5% is collected.

Question 23

Schillin test part 2

Answer 23

if part one is abnormal, repeat using b12 complexed to IF. If normal, diagnosis is PA. If abnormal, malabsoprtion.

Question 24

Conversion of THF (important)

Answer 24

requires B12. Also homocysteine to methionine production.

Question 25

THF function in nucleotide synthesis

Answer 25

THF donates methly grouo for uracil to thymidine conversion.

Question 26

Homocysteine to MMA to Succinyl COA

Answer 26

requires B12 in last step. This affects fatty acid synthesis. Which can cause neurological disorders and they ususally show up before anemia.

Question 27

Homocysteine buildup suggests:

Answer 27

B12 or folate deficiency

Question 28

MMA buildup suggests

Answer 28

B12 deficiency.

Question 29

normoblastic macrocytic anemia characterized by (determine megaloblastic non megaloblastic from each other)

Answer 29

ROUND not OVAL macrocytes. No howell Jolly Bodies. No hypersegmented neutrophils. No homocysteine or MMA buildup. Polychromasia and MCV between 100-110 fL.

Question 30

Most common cause macrocytic anemia:

Answer 30

alchoholism. Direct effect on erythropoesis. Liver disease affects RBC surivival and membrane protein composition.

Question 31

Aplastic anemia

Answer 31

pancytopenia hypocellularity. Can be idiopathic, but if responds to immunosupressants autoimmune. Chloramphenical, insecticides, chemotherapy, ionizing radiation. PNH. Fanconi anemia.

Question 32

pure red cell aplasia

Answer 32

hypocellularity of only RBC lineage.

Question 33

Fanconi anemia

Answer 33

many causes some mutations inolved DNA repair. More chromosomal breaks.

Question 34

Aplastic anemia therapy

Answer 34

transfusion, GCSF, GMCSF, bone marrow transplant, immunosupressive drugs.

Question 35

Transient erythroblastopenia

Answer 35

occurs after viral infection in children 4 years of age. Pure red cell aplasia.

Question 36

Chronic renal disease resultts in hypoproliferative anemias

Answer 36

Urea buildup. Dialysis may cause iron and folate deficiency.

Question 37

Distinguish megaloblastic non megaloblastic anemia

Answer 37

megaloblastic has macroovalocytes, howell jolly bodies, dacrocytes, hypersegmentation.

Question 38

Most recognizeable megaloblastic sign

Answer 38

hypersegmented neutrophils

Question 39

megaloblastic bone marrow

Answer 39

decreased M:E, hypercellular. Nuclear maturation defects and asynchrony in all lines.

Question 40

MMA and homocysteine levels in B12 and folate deficiencies

Answer 40

Homo cysteine elevated in both, MMA only elevated in B12 deficiency.

Question 41

Gastrin and IF ab in pernicious anemia diagnosis

Answer 41

gastrin is elevated because parietal cells make IF and HCl. When destroyed, decreased HCl causes increased gastrin. Also, anti IF antibodies present in majority of PA.