Megaloblastic/Macrocytic Anemia Flashcards
Megaloblastic/Macrocytic Anemia
-Defective DNA synthesis
-RNA synthesis continues
Megaloblastic/Macrocytic Anemia: Lab Findings
-All cell lines impacted: Leukopenia, thrombocytopenia
-Hypersegmentation of neutrophils
Anemia due to B12 deficiency is related to what disorders
-Deficiency of intrinsic factor: Gastrectomy/gastric bypass, Myxedema
-Malabsorption syndromes: Celiac disease, Crohn’s s disease, SIBO, chronic pancreatitis or prostate cancer
-Inadequate intake: Strict Vegans
MC cause of B12 deficiency
Pernicious anemia
Anemia d/t B12 deficiency: Patient presentation
-Gastrointestinal: Glossitis (sore, beefy, red tongue), weight loss (digestive issues), anorexia, constipation w/ diarrhea, poorly localized abdominal pain
-Neurological: May be present in absence of anemia
Anemia d/t B12 deficiency: Stages
- Peripheral nerve involvement (MC): Begins w/ numbness/tingling of hands/feet BL (more proximally)
- DWC (vibratory sense, position sense, ataxia)
- Spasticity, hyperactive reflexes, Babinski sign
Anemia d/t B12 deficiency: PE Findings
-Neuro: Decreased position/vibratory sense, abnormal reflexes, ataxia, Babinski sign (+), extremity numbness, paresthesias, Hypoalgesia “sock and glove”, poor finger coordination, Romberg’s sign (+), Vertigo, Weakness, Mental status changes
-Weight loss, glossitis, Hepatomegaly/splenomegaly, skin pigmentation changes, Anemia S/Sx
Anemia d/t B12 deficiency: Lab Findings
-CBC: Anemia (macro), increased RDW, mild leukopenia, mild thrombocytopenia
-PBS: Hypersegmented neutrophils
-Chem Panel: Serum bilirubin (unconjugated), LDH isoenzyme 1
-Special Tests: Serum B12 decreased, Autoanibodies to IF + parietal
-MMA (methyl melonic acid increases)
-Borderline low serum B12
Anemia d/t B12 deficiency: Management
-Emphasize meat/animal proteins, intramuscular B12 injections, Oral B12 (cyanocobalamin/methylcobalamin; 1,000-2,000 mcg daily), hemolytic correction (6 weeks), Neural improvement- up to 18 months
-Retest B12: ½ month after tx initiation improvement; Re-test every 6-12 months
-Precaustion: Folic acid w/o B12 with patients w/ pernicious anemia or B12 deficiency is contraindicated (sudden/severe neurologic symptom worsening)
Anemia d/t Folic Acid Deficiency is related to:
-Neutral tube defects, CVD, cancer, cognitive
-Folic acid necessary for adequate synthesis of certain purines/pyrmidines
-Vegetables, yeast, liver, mushrooms
-Absorption: Duodenum, jejunum
-Less liver storage
Deficient Dietary intake of Folic Acid leads to:
Tea/toasters, chronic alcoholic, chronic liver disease
Folic Acid deficiency looks the same as B12 EXCEPT:
RBC folate levels decrease
Increased requirements of Folic Acid are required for:
Pregnancy and lactation (MCC of B9 deficiency)
Anemia d/t Folic Acid Deficiency: Clinical Findings
-Anemia symptoms: Skin discoloration
-GI disturbances
-No neurological deficits
Anemia d/t Folic Acid Deficiency: Lab Findings
-CBC: Same as B12 deficiency
-PBS: Hypersegmented neutrophils/macrocytes
-Special Tests: RBC Folate
