Term
| Name the two classes of macrocytic anemias |
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Definition
| Macrocytic anemia with normoblastic maturation; macrocytic anemia with megaloblastic maturation. |
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Term
| Which class of macrocytic anemia has nuclear/cytoplasmic asynchrony? |
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Definition
| Macrocytic anemia with megaloblastic maturation |
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Term
| Alcoholism, liver disease, myeloproliferative disorders, myelodisplastic syndromes, hemolysis, and acute blood loss can all cause what kind of anemia? |
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Definition
| macrocytic anemia with normoblastic maturation. |
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Term
| In liver disease or chronic hepatitis, what changes occur in the red cell membrane? |
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Definition
| The rbc's have increased membrane surface with increased cholesterol and lecithin content. |
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Term
| What is a macroovalocyte? |
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Definition
| Large, oval red blood cell in peripheral blood; formed from megaloblastic maturation in bone marrow. |
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Term
| In megaloblastic anemia, which grows faster, the cytoplasm or the nucleus? |
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Definition
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Term
| What kind of anemia is associated with impaired DNA synthesis? |
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Definition
| Macrocytic anemia with megaloblastic maturation. |
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Term
| What are the two main causes of macrocytic anemia with megaloblastic maturation? |
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Definition
| Vitamin B12 or folate deficiency. |
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Term
| How does B12 or folate deficiency cause anemia? |
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Definition
| B12 and folate are necessary to make DNA. |
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Term
| A patient with anemia who also has a sore tongue probably has what kind of anemia? |
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Definition
| Macrocytic anemia with megaloblastic maturation, caused by B12 or folate deficiency |
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Term
| What clinical symptoms differentiate B12 deficiency from folate deficiency? |
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Definition
| Vitamin B12 deficiency causes neurological abnormalities not present with folate deficiency. |
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Term
| What does pancytopenia mean? |
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Definition
| decrease in all cellular elements- rbc's, wbc's, platelets |
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Term
| In a patient with macrocytic anemia with megaloblastic maturation, how would the rbc count, wbc count, and platelet count differ from normal? |
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Definition
| They are all decreased- pancytopenia. |
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Term
| What inclusions can be seen in a patient with macrocytic anemia with megaloblastic maturation? |
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Definition
| Howell Jolly bodies, basophilic stippling, Cabot rings. nRBC's also may be present. |
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Term
| Would you expect to see pappenheimer bodies in the blood smear of a patient with macrocytic anemia? |
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Definition
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Term
| What feature on the peripheral blood smear could be the first sign of megaloblastic dyspoiesis? |
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Definition
| hypersegmented neutrophils. |
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Term
| Describe the bone marrow of a patient with macrocytic anemia with megaloblastic maturation? (cellularity and M:E ratio) |
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Definition
| often hypercellular; M:E ratio decreased to 1:1 or lower. |
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Term
| What foods is vitamin B12 found in? |
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Definition
| meat, liver, seafood, eggs and milk. |
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Term
| Where does the body store vitamin B12, and how long do the stores last? |
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Definition
| 3-6 year store primarily in liver. |
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Term
| Which is a more common cause of B12 deficiency- inadequate intake, or impaired absorption? |
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Definition
| impaired absorption is almost always the cause of B12 deficiency. |
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Term
| What problem could be caused by gastrectomy, chronic gastritis, sprue, inflammatory bowel disease or ileal resection? |
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Definition
| Impaired absorption of vitamin B12 |
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Term
| Two ways that competing intestinal flora and fauna could cause impaired absorption of vitamin B12? |
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Definition
Blind loop syndrome- bacteria
Diphyllobothrium latum- fish tapeworm. |
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Term
| Cobalamin is also known as what? |
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Definition
|
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Term
| what is the vitamin B12 transport protein? |
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Definition
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Term
| What autoimmune disease could cause impaired absorption of vitamin B12? |
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Definition
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Term
| What is the disease called in which intrinsic factor is not secreted by the gastric mucosa? |
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Definition
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Term
| Name 4 things that the antibodies in pernicious anemia could be directed against? |
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Definition
| parietal cells, intrinsic factor, IF/B12 complex, complex binding sites. |
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Term
| What causes megaloblastic madness? |
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Definition
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Term
| Is it possible for vitamin B12 to cause neurological abnormalities without causing anemia? |
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Definition
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Term
| Name two diseases that megaloblastic madness can resemble? |
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Definition
| alzheimer's and schizophrenia. |
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Term
| What is pteroylglutamic acid? |
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Definition
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Term
| What foods is folate found in? |
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Definition
| leafy green vegetables, liver, meats and certain fruits. |
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Term
| How is folate stored in the body, and how long does it last? |
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Definition
| Folate is stored in the liver; usually enough supply for a few months. |
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Term
| Where in the body is folate absorbed? |
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Definition
| the duodenum and jejunum. |
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Term
| What is the leading cause of folic acid deficiency? |
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Definition
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Term
| Poor diet, overcooked vegetables, poverty, alcoholism and old age can all contribute to what? |
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Definition
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Term
| Alcohol has a direct antagonistic effect on the metabolism of what nutrient? |
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Definition
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Term
| What factors could contribute to increased utilization of folate? |
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Definition
| Chronic proliferation of cells as in hemolytic anemia, leukemia, metastatic cancer, pregnancy, sickle cell disease, infancy and young children. |
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Term
| A folate antagonist used in cancer therapy. |
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Definition
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Term
| Two laboratory methods used to differentiate macrocytic anemias. |
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Definition
| Microbiological assays, radioisotope methods. |
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Term
| When would a microbiological B12 or folate assay be considered invalid? |
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Definition
| if the patient is on antibiotics. |
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Term
| To differentiate between folate vs. B12 deficiency, which is quicker, microbiological assay or radioisotope methods? |
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Definition
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|
Term
| Differentiation of macrocytic anemias: The serum B12 is decreased, the serum folate is increased, and the red cell folate is decreased. B12 or folate deficiency? |
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Definition
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Term
| Differentiation of macrocytic anemias: The serum B12 is normal, the serum folate is decreased, and the red cell folate is decreased. B12 or folate deficiency? |
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Definition
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Term
| Differentiation of macrocytic anemias: The serum B12 is decreased, the serum folate is decreased, and the red cell folate is decreased. B12 or folate deficiency? |
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Definition
| Combined B12 and folate deficiency. |
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Term
| What is the Schilling test used to evaluate? |
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Definition
| The ability of the patient's intestinal tract to absorb B12. |
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Term
| When would you perform a Schilling test? |
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Definition
| After diagnosing a patient with B12 deficiency. |
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Term
| A patient has B12 deficiency. In the first stage of the Schilling test, 15% of the labeled dose is excreted in the patient's urine. What now? Do you know what's causing the deficiency? |
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Definition
| The patient probably has a dietary deficiency. |
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Term
| A patient has B12 deficiency. In the first stage of the Schilling test, 4% of the labeled dose is excreted in the patient's urine. What now? Do you know what's causing the deficiency? |
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Definition
| Now the second stage of the Schilling test has to be done to differentiate between pernicious anemia and malabsorption problem. |
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Term
| A patient has B12 deficiency. In the first stage of the Schilling test, 5% of the labeled dose is excreted in the patient's urine. In the second stage, 5% is excreted. What is indicated by this? |
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Definition
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Term
| A patient has B12 deficiency. In the first stage of the Schilling test, 1% of the labeled dose is excreted in the patient's urine. In the second stage, 50% is excreted. What does this indicate? |
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Definition
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Term
| What is given in the second stage of the Schilling test that is not given in the first? |
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Definition
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Term
| What two factors might invalidate the Schilling test? |
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Definition
| Incomplete urine collection; impaired renal function. |
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Term
| What is achlorohydria and what does it indicate? |
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Definition
| Achlorohydria is the absence of free HCL in the gastric juices after histamine stimulation. Achlorohydria is indirect evidence of pernicious anemia. |
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Term
| Name two substances secreted by the parietal cells? |
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Definition
| intrinsic factor (IF) and hydrochloric acid (HCL) |
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Term
| Increased excretion of MMA in urine is indirect evidence for what? |
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Definition
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Term
| What does MMA stand for, and what is the significance of it? |
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Definition
| Urine methylmalonic acid; increased urine MMA levels could indicate B12 deficiency. |
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Term
| What does homocysteine indicate, and what body fluid is it found in? |
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Definition
| It's measured in plasma and it's increased in patients with B12 or folate deficiency. |
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Term
| What substance in serum has a predictive value for increased risk of MI and venous thrombosis, and also is an early detector of B12 deficiency? |
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Definition
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Term
| A patient has increased MCV, decreased Hgb and Hct, and increased retic count. What is the likely diagnosis? |
|
Definition
| Anemia secondary to bleeding, hemolysis or response to therapy. |
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Term
| A patient has increased MCV, decreased Hgb and Hct, and round macrocytes present in the smear. No other morphological oddities are noted. What is the probable diagnosis? |
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Definition
| Normoblastic macrocytic anemia secondary to liver disease, alcoholism, MDS, MD. |
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Term
| A patient has increased MCV, and decreased Hgb and Hct. The peripheral smear shows macroovalocytes, dacryocytes, Howell Jolly Bodies and the occasional hypersegmented neutrophil. What is the probable diagnosis? |
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Definition
| Macrocytic anemia with megaloblastic maturation secondary to B12 or folate deficiency. |
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