part 5

Question 1

• defective DNA synthesis

- majority resulting from deficiency in cobalamin (B12) required for RBC formation, and folic acid

Answer 1

-megaloblastic anemias

Question 2

• intrinsic factor is not secreted and cobalamin is not absorbed
• commonly causes pernicious anemia: absent IF, insidious onset, middle age, AA
• can also occur: GI surgery, chronic diseases, excessive alcohol and hot tea, smoking, long term H2 histamine receptor blockers, PPIs, and strict vegetarians
• manifestations develop slowly due to hypoxia, beefy, red, sore, tongue. weakness and paresthesia of feet and hands, impaired thought process
• RBCs have fragile cell membranes and abnormal shapes
• low cobalamin levels

Answer 2

Megaloblastic Anemias-Cobalamin deficiency

Question 3

What is the treatment for Megaloblastic Anemias-Cobalamin deficiency?

Answer 3

parenteral or intranasal cobalamin (vit B12)

• pt’s will die in 1-3 years without tx
• can be reversed but longstanding complications may not be reversible

Question 4

• clinical manifestations similar to cobalamin deficiency
• commonly caused by alcohol abuse (malabsorption and dietary deficiency), dietary, malabsorption, drugs, anorexia
• decreased sesation to heat and pain from neurological impairment

Answer 4

megaloblastic folic acid deficiency anemia

Question 5

What differentiates folic acid vs cobalamin (B12) megaloblastic anemia?

Answer 5

absence of neurologic problems with folic acid deficiency

Question 6

What lab will differentiate between the 2 megaloblastic anemias?

Answer 6

-folic acid level
va
-B12 level

Question 7

What is the Tx for megaloblastic folic acid deficiency anemia?

Answer 7

• replacement therapy
• 1mg/day folic acid
• foods high in folic acid

Question 8

• underproduction of RBCs
• shortening of RBC survival
• normocytic, normochromic, and hypo proliferative RBCs
• usually mild but can be severe if untreated
• can be caused by kidney failure w/out dialysis
• increased ferritin and iron stores
• normal folate and cobalamin levels
• treat underlying cause
• Eopoetin alfa IV or SQ

Answer 8

anemia of chronic diseases: anemia of inflammation

Question 9

• pancytopenia: decrease in all blood cell types (RBC, WBC, and platelets)
• hypocellular bone marrow (not producing)
• ranges from chronic to critical
• rare, abrupt or gradual
• acquired, idiopathic, autoimmune
• symptoms are caused by suppression of any or all bone marrow
• manifestations: fatigue, dyspnea, cardiovascular, cerebral, neutropenia, septic shock, death, thrombocytopenia, petechiae, more yellow marrow (fat) than red
• Labs: low Hgb, WBC, platelet, reticulocyte, elevated iron and TIBC

Answer 9

aplastic anemia

Question 10

What is the worst type of anemia you can have?

Answer 10

aplastic anemia

Question 11

What is the management of aplastic anemia?

Answer 11

• remove causative agent
• supportive care
• prevent hemorrhage
• immune therapies and bone marrow transplantation can be curative