ANEMIAS II

Question 1

etiology of megaloblastic anemia?

Answer 1

deficiency of cobalamin and folic acid

Question 2

major tx for megaloblastic anemia?

diet and meds

Answer 2

vegans and strict vegetarian
adult>75 yrs
PPIs and H2 blockers>12 mo
use of metformin for >4 mo

Question 3

reduced lactate uptake by the liver, and lactic acidosis being uncommon as a side effect of metformin? T/F

Answer 3

t

Question 4

how does cobalamin (B12) deficiency present clinically?

neurologic?

diagnosis?

Answer 4

anemia
pallor
lemon tinge to skin
slight scleral icterus
beefy red, smooth tongue

peripheral neuropathy
muscle weakness
ataxia
dementia

history and physical exam
CBC
vit B12 level abnormal
cobalamin deficiency

Question 5

inherited in an autosomal recessive manner

Hb SS homozygotes have severe hemolytic anemia

hemoglobin range 6-9 g/dL

elevated reticulocyte counts

what is this illness?

Answer 5

sickle cell disease or hemolytic anemia

Question 6

major clinical indicators of SCD?

Answer 6

painful crises

acute chest syndrome

neurologic: CNS complications, decreased cerebral blood flow, subclinical impairment of cognition

CVD: pulmonary dysfunction, low resting PaO2, acute chest syndrome + chronic hypoxemia (possible LV dilatation)

hepatobiliary: chronic hemolytic anemia leading to gallstones

aseptic necrosis

skin ulceration

monocular blindness with retinal damage from arterial occlusion

Question 7

how is SCD managed?

Answer 7

painful crisis with supplemental oxygen, treat fluid, electrolyte and acid base balances, analgesia

Abx

RBC exchange

hydroxyurea

stem cell transplant, only curative option