Macrocyctic anaemia Flashcards
1
Q
What is the definition of macrocyctic anaemia?
A
↓ red blood cell count due to problem with the synthesis red blood cells
2
Q
What is the pathophysiology of macrocytic anaemia?
A
- Macrocysts and a ↑ MCV (large cells)
- Classified into megaloblastic and non megaloblastic
- Megaloblastic: delayed maturation of the nucleus of erythroblast in the bone marrow due to defective DNA synthesis. Large and large immature nuclei. Giant metamyelocytes are seen (twisted nuclei)
- Due to block in DNA synthesis as the methyl group required is supplied by the folate coenzyme
- Normoblastic: normal nucleated erythroblast
3
Q
What are the risk factors/aetiology of macrocytic anaemia?
A
- B12 deficiency/Pernicious anaemia - megaloblastic
- Folate deficiency - megaloblastic. Causes include: poor diet, poverty, elderly, poor absorption, anti-folate drugs
- Cytotoxic drugs – megaloblastic
- Alcohol – non megaloblastic/normoblastic
- Reticulocytosis – non megaloblastic/normoblastic
- Liver disease – non megaloblastic/normoblastic
- Hypothyroidism – non megaloblastic/normoblastic
- Pregnancy – non megaloblastic/normoblastic
- Drugs e.g. azathioprine – non megaloblastic/normoblastic
- Myelodysplasia – type of cancer in which the bone marrow does not make enough healthy normal blood cells
- Myeloma
- Myeloproliferative disorders
- Aplastic anaemia – failure of bone marrow development
4
Q
What are the signs/symptoms of macrocytic anaemia?
A
- Weakness
- Fatigue
- Headaches
- Faintness
- SOB on exertion/angina/intermittent claudication
- Palpitations/Tachycardia
- Bounding pulse
- Systolic flow murmur
- Loss of appetite
- Weight loss
- Pale complexion
- Lemon-yellow complexion
- Glossitis
- Angular stomatitis
- Symmetrical paraesthesia in the finger and toes – severe B12 deficiency
- Early loss of vibration sense and proprioception – severe B12 deficiency
- Progressive weakness and ataxia – severe B12 deficiency
- Dementia – severe B12 deficiency
- Psychiatric problems – severe B12 deficiency
- Hallucinations/delusions – severe B12 deficiency
- Optic atrophy – severe B12 deficiency
5
Q
What investigations are conducted for suspected macrocyctic anaemia?
A
- Serum B12/Holotranscobalamin
- Serum folate/ red cell folate
- Blood film – hypersegmeneted polymorphs
- WCC
- Platelet count
- Reticulocyte count – bone marrow activity
- Serum bilirubin - ↑ due to ineffective erythropoiesis
- Lactate dehydrogenase - ↑ due to ineffective erythropoiesis
- LFT
- TFT
- Bone marrow biopsy
6
Q
What are the surgical treatments for macrocytic anaemia?
A
Blood transfusion
7
Q
What are the pharmacological treatments for macrocytic anaemia?
A
- Folic acid
* B12 injections
8
Q
What are the non pharmacological treatments for macrocytic anaemia?
A
• If folate deficient, increase consumption of green vegetables, nuts, yeast and liver
