Macrocytic Anemia

Question 1

Folate Deficiency
1. Diet
2. Malabsorption
3. Increased Demand
4. Drugs
5. Inherited

Answer 1

1. Common (result of Alcoholism)
2. Sprue
3. Pregnancy, hemolysis
4. Methotrexate
5. None

Question 2

Vitamin B12 deficiency
1. Diet
2. Malabsorption
3. Increased Demand
4. Drugs
5. Inherited

Answer 2

1. Rare (strict vegetarians)
2. Pernicious anemia, Postgastrectomy, pancreatic insufficiency, Crohn disease, D. latum infection
3. Pregnancy, hemolysis
4. Dilantin
5. Transcobalamin II deficiency

Question 3

Peripheral blood picture of Folate and B12 deficiency

Answer 3

Oval macrocytosis, Hypersegmented neutrophils, Pancytopenia (when severe), Anisopoikilocytosis (variable)

Question 4

Bone marrow condition in Folate and B12 deficiency

Answer 4

Hypercellularity, megaloblastic changes, erythroid hyperplasia with left shift

Question 5

Blood chemistry of Folate deficiency

Answer 5

⬆️ LD
⬆️ Bilirubin 1
⬇️ serum and RBC Folate
⬆️ urinary Formiminoglutamic acid (FIGLU)

Question 6

Blood chemistry of Vitamin B12 deficiency

Answer 6

⬆️ LD
⬆️ Bilirubin 1
⬇️ serum B12 and RBC Folate
⬆️ urinary Methylmalonic acid