BLI 7 - Macrocytic Anemia (Siddiqui)

Question 1

Salivary gland secretion

Answer 1

R-binder

Question 2

Increased serum methylmalonic acid

Answer 2

Megaloblastic - B12 deficiency only!

Question 3

Microcytic sideroblastic anemia

Answer 3

Alcohol can also produce this

Question 4

alcohol liver disease hypothyroidism MDS reticulocytosis

Answer 4

non-megaloblastic

Question 5

Jejunum

Answer 5

folic acid absorption

Question 6

Cofactor for conversion of homocysteine to methionine

Answer 6

Vit B12

Question 7

Inhibits dihydrofolate reductase

Answer 7

MTX

Question 8

Terminal ileum

Answer 8

B12 absorption

Question 9

Years to develop

Answer 9

B12 deficiency

Question 10

Alcoholics Pregnancy Hemolysis

Answer 10

Folate deficiency

Question 11

Autoimmune destruction of gastric parietal cells

Answer 11

Pernicious anemia –> no intrinsic factor

Question 12

Dissociates cobalamin (B12) from R-binder

Answer 12

Pancreatic enzymes

Question 13

Gastric parietal cell secretions

Answer 13

R-binder Intrinsic Factor

Question 14

Leafy green vegetables

Answer 14

Folic acid

Question 15

N10 Formyl THF

Answer 15

Purine synthesis

Question 16

Months to develop

Answer 16

Folate deficiency

Question 17

Impaired DNA synthesis

Answer 17

Megaloblastic anemia

Question 18

Gastrectomy Ileal resection Pancreatic insufficiency Crohn disease Diphyllobothrium latum Vegans (Not vegetarians)

Answer 18

B12 deficiency

Question 19

Animal derived foods

Answer 19

B12

Question 20

Cytoplasmic dyssynchrony - maturation of nucleus of bone marrow precursor cells is delayed relative to maturation in cytoplasm

Answer 20

megaloblastic

Question 21

hypersegmented neutrophils

Answer 21

megaloblastic

Question 22

Round macrocytes

Answer 22

Non-megaloblastic

Question 23

Enzyme to convert folic acid to THF

Answer 23

Dihydrofolate reductase

Question 24

Absent neutrophil hypersegmentation

Answer 24

Non-megaloblastic

Question 25

Increased serum homocysteine

Answer 25

Megaloblastic - B12 or Folate deficiency

Question 26

The Cbl-\_\_\_\_ complex is taken up by endocytosis, the Cbl is liberated, and converted to two coenzyme forms (\_\_\_-Cbl, adenosyl-Cbl)

Answer 26

TCII methyl

Question 27

N5 methyl THF

Answer 27

Methionine synthesis

Question 28

Pernicious anemia

Answer 28

B12 deficiency

Question 29

Most common cause of macrocytosis

Answer 29

Alcoholism

Question 30

MCV 100-110

Answer 30

Non-megaloblastic anemia

Question 31

Cofactor for methylmalonyl CoA to Succinyl CoA

Answer 31

Vit B12

Question 32

Negative lab important for dx of folate deficiency

Answer 32

NL methylmalonic acid level

Question 33

Parasthesias Weakness Visual impairment

Answer 33

Megaloblastic

Question 34

Drugs associated with megaloblastic anemia

Answer 34

MTX Sulfa Trimethoprim Phenytoin

Question 35

Increased lab values (2) in B12 deficiency

Answer 35

Homocysteine Methylmalonic Acid

Question 36

MCV \> 110

Answer 36

megaloblastic anemia

Question 37

\_\_\_\_\_\_ folate is more reliable, as it remains stable over time

Answer 37

RBC (more reliable than serum)

Question 38

N5,N10 methylene THF

Answer 38

Thymidine synthesis