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Senior - Heme-Onc > Lecture 3 - Macrocytic Anemia > Flashcards

Lecture 3 - Macrocytic Anemia Flashcards

(53 cards)

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1
Q

MCV >100?

A

Macrocytic anemia

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2
Q

Basic mechanism of anemia? (Causes)

A

RBC disruption

  • dietary deficiency
  • abnormal metabolism of B12/folate
  • ineffective erythropoiesis
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3
Q

If MCV > 100 you need to test for?

A

B 12

Folate

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4
Q

MCV >100 with
- Low vitamin B12

What may cause this?

A

Megaloblastic anemai (pernicious anemia)

Think:

  • dietary deficiency
  • GI disease
  • Post-gastrectomy
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5
Q

MCV >100 with:
- low folate?

What may cause this?

A

Megaloblastic anemia

Dietary deficiency
GI disease

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6
Q

MCV > 100 with:

- normal B12 and folate?

A

Liver diseases
Myelodysplastic syndrome
Reticulocytosis

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7
Q

Common causes of macrocytosis.

Its a long list, dont memorize it

A

DNA metabolism

  • B12
  • folate
  • Drugs
    • Hydroxuriea
    • methotrexate

Shift to immature or stressed RBC

  • reticulocytosis
  • aplastic anemia

Primary bone marrow disorder
- myelodysplastic syndromes

Liver abnormalities

  • liver disease
  • hypothyroidism
  • hyperlipidemia

MOA ukn
- ETOH

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8
Q

Pt has macrocytic anemia with normal B12 and folate

You find Hypersegmented neutrophils on peripheral smear

A

Strongly suggest megalobastic anemia

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9
Q

Pt has macrocytic anemia with normal B12 and folate

No nutritional or drug induced cause.
Look at how high the MCV is

100:

> 105:

A

100

  • hypothyroidism,
  • pregnancy,
  • liver disease,
  • ETOH

> 105: bone marrow d/o (MDS)

  • late megalobastic anemia
  • pernicious anemia
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10
Q

Common social causes of macrocytic?

A

ETOH

Drugs

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11
Q

Macrocytic anemia iwth microcytes and macrocytes on peripheral smear

A

Pt has coexisting condition probably:

  • IDA
  • Thalassemia
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12
Q

What is megaloblastic anemia?

A

A type of macrocytic anemia

A group of blood disorders that share common morphological characteristics (large, atypical)

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13
Q

MC cause of megalobastic anemia?

A

B12 and folic acid deficiency (usually intake problem, looking at you jake)

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14
Q

What do folate and B12 do for the body?

A

Purine synthesis and subsequent DNA synthesis

  • leads to abnormal erythropoiesis
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15
Q

What is the biggest concern for untreated B12 deficiency?

A

Neuropsychiatric symptoms (late sign)

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16
Q

B12 deficiency essentials of diagnosis?

A
  • MCV > 100
  • Macro-ovalocyutes and hypersegmented neutrophils
  • serum B12 low
    • <170g/mL (low)
    • 200-300 (borderline)
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17
Q

If B12 is 200-300 order?

A

MMA (methylmalonic acid)

Homocysteine

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18
Q

Why High MMA with low b12?

A

B12 is a cofactor in conversion of methylmalonyl-CoA succinyl-CoA in the mitochondria

Thus low B12 leads to accumulation of MMA

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19
Q

Where does B12 come from?

A

Animals

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20
Q

How much B12 do we store and use? How long can we go w/ out it?

A

Liver stores 2000-5000mcg

Daily use is 3-5mcg

You have approx 3 yrs till you need more

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21
Q

Cause of B12 deficiency?

A

Strict Vegans

Abdominal surgery

Rare causes

  • fish tapeworm
  • severe crohn’s
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22
Q

Clinical findings of B12 deficiency?

Study These Flashcards
A 
Megaloblastic anemia
- Fatigue, palor, malaise, SOB
HCT < 10-15%
Changes in mucosal cells 
- glossitis, Gi complaints

Neuropsychiatric symptoms

23
Q

Describe neuropsychatric symptoms

Study These Flashcards
A

Peripheral nerves first -> paresthesias
Balance problems -> ataxia
Cerebral function leading to dementia (late)

24
Q

What are the 2 steps required for the body to absorb b12?

Study These Flashcards
A
  1. Hydrochloric acid separates b12 from carier protein

2. B12 combines w IF for absorption in TERMINAL ILEUM

25
Pts with Pernicious Anemia have? (Causes)
Antibody to IF or parietal cells | Parietal cells are the site of production of IF
26
What does folate (b9) do in the body?
It is a co-factor in cellular reactions, but does not participate in methylmalonic acid metabolism (MMA) - so normal MMA on labs
27
Sources of B9?
Fruits (citrus) | Green leafy vegetables
28
What is entherohepatic recirculation?
One of 2 methods for absorption of B9 (folate) The B9 rides the bile train back into the intestine The other method is normal absorption
29
Storage and use of B9?
Store about 5000 mcg You use lots of it so you only have weeks to months worth of supply
30
What is a “dual deficiency” (folate deficiency)
Caused by ETOH abuse - interferes w initial absorption - f’s with enterohepatic circulation
31
Causes of folate deficiency?
Nutritional causes Increased requirements (pregg) Malabsorptive causes (rare but may be GI or drugs)
32
What drugs are associated w B9 deficiency?
ETOH (its medicine, dont judge me) ``` Methotrexate Sulfasalazine (ASA derivative) Triamterene (K sparing diuretic) Pyrimethamine (antiparasitic) Trimethoprim/sulfam ethozazole Diphenylhydatoin (phenytoin) Barbituates Topiramate Hydroxyurea ```
33
What is different about ETOH, topiramate, and hydroxyurea induced anemia?
They cause drug-induced macrocytic anemia with or without interfering w folate
34
Clinical features of B12 and folate (list)
``` Hematologic Cardiopulmonary GI Derm Genial Reproductive Psych NEUROPSYCHIATRIC (B12 specific) ``` See slide 29 for more in depth stuff
35
One more time, what blood work is required for DX of megaloblastic anemias?
``` Direct B12 and folate - B12 <170pg/mL - B9 < 150ng/mL Homocysteine level MMA ```
36
Tx of asymptomatic B12 macrocytic anemia or b12 deficiency induced peripheral neuropathy
B12 PO: 1000mcg daily Or IM: 1000 mcg once monthly If asymptomatic
37
TX for perinicious anemia and neurological dysfunction?
You win shots for life (must be parenteral) 1000mcg IM daily x 1 week, then weekly x 4 weeks, then monthly x life
38
Tx for neurologic dysfunction only
B12 - Can take PO once initial deficiency has been corected and pt is asymptomatic Folate
39
How fast do you see improvement when treating B12?
Erythropoiesis starts to normalize w/in 1-2 days Hypersegmented neutrophils get better in 10-14 days
40
How to treat folate deficiency?
Oral B9 1mg PO daily x 1-4 months or until mo-better
41
Why does liver disease cause macrocytic anemia?
It impairs lipid metabolism | - we think excess lipids are deposited in RBC lipid bilayer resulting in increased size (macrocytosis)
42
Beside absorption why does ETOH cause macrocytic anemia?
Direct bone marrow toxicity Abnormal RBC lipid metabolism (like liver disease) Interferes w folate metabolism
43
Will alcohol induced macrocytic anemia get better?
Usually w/in 2-4 months of abstinence if irreversible damage has not occurred
44
Myelodysplastic syndrome s (MDS) is aka?
Pre-leukemia
45
What is myelodysplastic syndrome (MDS)?
Heterogeneous bone marrow disorders characterized by ineffective blood cell production and dysplasia due to mutation in a hematopoietic stem cell
46
What causes MDS?
Primary: idiopathic Secondary: med treatments - chemo - radiation therapy - toxic substances (benzene)
47
MDS clinical features?
- Hematologic (MCV 105+) (cytopenias) - increased risk of AML (leukemia) (roughly 30% get this) - present w fatigue, infection or bleeding - indolent presentation (wasting, fever) - +/- splenomegaly
48
MDS diagnosis?
Cytopenia w hypercellular bone marrow Morphologic abnormalities in 2 or more hematopoietic cell lines Get a bone marrow biopsy
49
MDS tx?
No single therapy - transfusions - hematologic stimulating factors - bone marrow transplant - experimental shit (chemo, immunosuppression etc)
50
Marked reticulocytosis?
MCV spuriously increased when there are excessive reticulocytes in the peripheral blood. Usually transiently observed in patients with massive hemolysis without a coexisting microcytic process
51
Hypothyroidism?
Mechanisms unknown. Hypothyroid patients should also be evaluated for pernicious anemia due to chronic autoimmune thyroiditis
52
Pregnancy for other macrocytic ?
INCREASED folate requirements may account for mild macrocytosis which is rarely OVer 100. Folate supplementaiton during pregnancy also significantly reduces risk of neural tube defects in child.
53
Um, no mr vance
AB caffeinated is not a blood type

Senior - Heme-Onc (6 decks)

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