Macrocytic Anaemia

Question 1

What issues can cause malabsorption?

Answer 1

Lack of intrinsic factor in the stomach, terminal ileum problems

Question 2

What is pernicious anaemia?

Answer 2

An autoimmune condition where atrophic gastritis leads to a lack of IF secretion from parietal cells and therefore dietary B12 remains unbound and cannot be absorbed

Question 3

How does a B12 deficiency cause anaemia?

Answer 3

B12 is needed to synthesise thymidine and therefore DNA. This leads to slow RBC production

Question 4

What investigations would you do for pernicious anaemia?

Answer 4

Parietal cell antibodies, IF antibodies

Question 5

What can cause macrocytic anaemia?

Answer 5

B12/folate deficiency, excess alcohol/liver disease, hypothyroidism, bone marrow failure

Question 6

What are signs specific to pernicious anaemia?

Answer 6

Angular stomatitis, lemon-yellow skin, neurological features

Question 7

How would you treat macrocytic anaemia caused by diet?

Answer 7

Oral B12

Question 8

How would you treat folic acid deficiency?

Answer 8

Folic acid tablets daily for 4 months

Question 9

How would you treat pernicious anaemia?

Answer 9

B12 injections, oral B12

Question 10

What is a sign of macrocytic anaemia caused by hypothydoisism?

Answer 10

Reduced reflexes