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Haematology > 2: Macrocytic anaemia and macrocytosis > Flashcards

2: Macrocytic anaemia and macrocytosis Flashcards

(40 cards)

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1
Q

What MCV defines macrocytosis

A

> 96

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2
Q

What are the 3 types of macrocytosis

A
  1. Megaloblastic
  2. Non-Megaloblastic
  3. Other
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3
Q

What are 3 causes of megaloblastic macrocytosis

A

Vitamin B12 Deficiency
Folate Deficiency
Anti-Folate Medications

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4
Q

How long do vitamin B12 stores usually last

A

3-5 years

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5
Q

What condition can lead to vitamin B12 deficiency

A

Pernicious anaemia

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6
Q

How long do folate stores last

A

3-months

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7
Q

What are 4 anti-folate medications

A

Trimethoprim
Phenytoin
Methotrexate
Hydroxyurea

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8
Q

What are non-megaloblastic causes of macrocytic anaemia

A 
Hypothyroidism 
Pregnancy 
Macrocytosis 
Reticulocytosis 
Liver Disease
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9
Q

What are 4 other causes of microcytic anaemia

A
  • MDS
  • MPD
  • Myeloma
  • Aplastic anaemia
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10
Q

Explain pathophysiology of macrocytic anaemia

A
  • Macrocytosis is due to a defect in DNA production
  • It is where cells do not have the correct number of DNA copies.
  • In response cells keep increasing in size
  • If too large cells will undergo intra-medullary haemolysis causing anaemia
  • To compensate bone marrow increases cell production resulting in megalocytosis
  • Megalocytosis also happens to other cells causing hyper-segmented neutrophil appearance
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11
Q

What is first-line in anaemia

A

FBC

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12
Q

What is looked at after FBC

A

Vitamin B12 and Folate

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13
Q

What is then looked at

A

Peripheral blood smear

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14
Q

What will be seen on peripheral blood smear

A

Hyper-segmented neutrophils if megaloblastic

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15
Q

When is a bone marrow biopsy indicated

A

If cause not identified by previous tests

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16
Q

How long does the body store folate for

A

3-months

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17
Q

Where is folate absorbed

18
Q

What can lead to folate deficiency

Study These Flashcards
A
  • Alcoholism
  • Malnutrition
  • Increased demand: pregnancy, coeliac disease
  • Anti-Folate medications
19
Q

How is folate deficiency managed

Study These Flashcards
A

Folic acid supplementation

20
Q

What should folic acid always be given with and why

Study These Flashcards
A

B12.

If Folic acid is given in B12 deficiency it can precipitate subacute combined degeneration of the spinal cord

21
Q

How much folic acid is given routinely in pregnancy

22
Q

What should always be given before folate

Study These Flashcards
A

Vitamin B12

B4 Folate

23
Q

What is the role of vitamin B12

Study These Flashcards
A

Vitamin B12 helps synthesise thymidine and therefore is required for RBC and DNA synthesis

24
Q

How long do vitamin B12 stores last

25
Where is vitamin B12 absorbed
Terminal Ileum
26
What can cause vitamin B12 deficiency
- Poor Intake | - Malabsorption
27
What can lead to poor intake of vitamin B12
B12 is found in meat and fish - therefore vegans can be deficient
28
What malabsorption conditions can lead to vitamin B12 deficiency
- Pernicious anaemia - Gastrectomy Conditions affecting terminal ileum: - Crohn's - Ileal resection - Topical sprue - Bacterial overgrowth
29
What dermatological feature has been described in vitamin B12 deficiency
Lemon-tinge to skin
30
Why is a lemon tinge to skin described in vitamin B12 deficiency
Jaundice and anaemia
31
What are neurological complications of vitamin B12 deficiency
- Neuropsychiatric: Depression | - Neurological: Sub-acute combined degeneration spinal cord, peripheral neuropathy
32
How does subacute combined degeneration spinal cord present
Mixed UMN and LMN. Often with classic triad of: 1. Upgoing plantar 2. Absent knee jerk 3. Absent ankle jerk
33
Explain pernicious anaemia
Autoimmune disorder causing atrophic gastritis and preventing parietal cells releasing IF which is required for absorption vitamin B12 in terminal ileum
34
What are RF for pernicious anaemia
- Over 40 - Other autoimmune diseases - Blood-group A
35
What cancer does pernicious anaemia increase risk of
Gastric carcinoma
36
Explain FBC in pernicious anaemia
Macrocytic anaemia
37
Explain vitamin B12 in pernicious anaemia
Low
38
Explain parietal cell antibodies in pernicious anaemia
Parietal cell antibodies (90%)
39
How is pernicious anaemia managed
IM Vitamin B12
40
What is vitamin B12 called
Hydoxocobalamin

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