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Macrocytic anemias
megaloblastic and normoblastic maturation
62
Health Care
Undergraduate 4
06/06/2009

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