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Macrocytic anemia Flashcards

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1
Q

Macrocytic Anemia

A

> 100

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2
Q

If considering macrocytic anemia, must test?

A

Vit b12

Folate

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3
Q

> 100 MCV + low b12 suspect

A

Megaloblastic anemia (pernicious anemia)
Dietary deficits
GI disease
Post-gastrectomy

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4
Q

> 100 MCV + low folate suspect

A

Megaloblastic anemia
Diet deficits
GI disease

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5
Q

> 100 MCV + NL b12/folate suspect

A

Some liver diseases
Myelodysplastic syndrome
Reticulocytosis

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6
Q

Macrocytosis and ABNL DNA metabolism causes

A 
Vb12 deficits
Folate deficits
Rx 
-hydroxyurea
-methotrexate
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7
Q

Macrocytosis and Shifts to immature/stressed RBCs causes

A

Reticulocytosis

Aplastic anemia

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8
Q

Macrocytosis and primary BM D/O causes

A

Myelodysplastic syndromes

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9
Q

Macrocytosis and ABNL lipids causes

A

Liver disease
Hypothyroidism
Hyperlipidemia

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10
Q

Macrocytosis W/ unknown mechanism of action causes?

A

Etoh abuse

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11
Q

Macrocytic anemia and smear findings

A

Hypersegmented neutrophils

Macro-ovalocytes

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12
Q

Megaloblastic anemia is

A

A macrocytic anemia that is ass/w ABNL DNA synth of RBCs 2/2 vit b12/folate deficits

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13
Q

100-105 MCV ddx

A

Hypothyroidism
Pregnancy
Chronic liver disease
Etoh Abuse

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14
Q

> 105 MCV ddx

A

Bone marrow D/O like MDS
Late megaloblastic anemia
Pernicious anemia

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15
Q

Purpose of vb12/folate?

A

Role in DNA synthesis

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16
Q

Vb12 deficits results in what concerning growth factors?

A

Abnl EPO (ineffective)

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17
Q

Vb12 is found in what foods?

A

Animal products

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18
Q

Vb12 is stored in what organ?

A

Liver

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19
Q

How long before Vb12 deficits until anemia develops?

A

> 3yr

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20
Q

Etiology of Vb12 deficits?

A

Strict vegan
Abd surgery - gastrectomy/ileum resection
IBD - severe crohns affecting ileum

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21
Q

Gastrectomy causes what to happen concerning Vb12?

A

Eliminates intrinsic factor sites of production

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22
Q

Ileum resection causes what to happen concerning Vb12?

A

Eliminates site of b12 absorption

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23
Q

Neuropsychiatric syndrome is

A

Neuro changes occurring in order over a number of years of untreated Vb12 deficits

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24
Q

Neuropsychiatric syndrome order of changes

A

1st - peripheral neuropathy
2nd - ataxia
3rd - Dementia

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25
Vb12 dx criteria
>100 MCV macro-ovalocytes Hyperseg neutrophils <170 Vb12
26
Vb12 level ranges
``` >300 = no deficits 170-300 = grey-eval more <170 = deficit ```
27
Vb12 indeterminate Level of 170-300 additional tests?
``` Methymalonic acid (MMA) Homocysteine ```
28
Elevated MMA+homocysteine =
Vb12 deficits
29
Vb12 purpose in the DNA process?
Cofactor that helps convert methylmalonyl-CoA to succinyl-CoA in mitichondria
30
A lack of B12 during cofactor conversion leads to?
MMA accumulation
31
Pernicious anemia is at its basic?
A form of Vb12 deficit
32
Vb12 absorption occurs when
Hydrochloric acid in stomach seperates vb12 from carrier protein then combines to intrinsic factor for absorption in terminal anemia
33
Pernicious anemia occurs when?
Anti-intrinsic factor antibodies or | Antibodies to parietal cells
34
What produces intrinsic factor in the stomach?
Parietal cells
35
Pernicious anemia etiology
Strong hereditary | White predominance
36
Pernicious anemia dx criteria
Confirmed by b12 deficits Normal folate Pos - anti-intrinsic factor autoantibodies
37
Vb12 deficit asymptomatic or peripheral neuropsthy txt
PO or IM b12 PO - 1000mcg/d IM - 1000mcg/mo
38
Vb12 deficits w/ pernicious anemia AND neuro dysfx TXT
B12 must be parenteral IM 1000mcg/D 1st week > weekly for a month > monthly for life AND folic acid
39
Vb12 deficits w/ neuro dysfx only Txt
Same as pernicious anemia+neuro dysfx but switch to PO 1000mcg indefinitely only after deficit is corrected and pt is asymptomatic AND folic acid
40
After vb12 txt when does EPO and hyperseg neutrophils correct
EPO - w/in 1-2D | Hyperseg - disappears 10-14D
41
Does folate participate in MMA metabolism?
NO
42
Folate deficit and MMA/homocysteine levels?
NL - MMA | elevated homocysteine
43
Folate comes from what food source?
Plant matter | Fruit, green leafy vegs
44
Folate deficit causes
Nutritional Increased requirements Malabsorptive
45
Nutritional causes of folate deficits
(MC) Decreased diet intake | Alcoholics (dual deficiency - absorption/enterohepatic circulation ABNLs)
46
Increased requirements of folate deficits
Physiologic - pregnancy/infancy | Pathologic - hemolytic anemia
47
Malabsorptive causes of folate deficits
Drugs | ABNL GI conditions
48
Rx that affects folate?
``` Etoh Methotrexate (RA, CPP) Sulfasalazinr Triameterene Pyrimethamine TMP/SMX Phenytoin Barbs Topiramide Hydroxyurea ```
49
Folate deficit anemia starts when?
Weeks to Months
50
Folate deficit TXT
PO replacement | 1mg/D for 1-4mo until hematologic recovery
51
Megaloblastic anemia (b12 and/or folate deficit) clinical features - HEMATOLOGIC
Macrocytic anemia; pancytopenia w/ megaloblastic BM
52
Megaloblastic anemia (b12 and/or folate deficit) clinical features - CARDIOPULM
CHF
53
Megaloblastic anemia (b12 and/or folate deficit) clinical features - GI
Macroglossitis | Malabsorption syndromes
54
Megaloblastic anemia (b12 and/or folate deficit) clinical features - DERMATOLOGIC
Melanin pigmentations | Prematuring graying
55
Megaloblastic anemia (b12 and/or folate deficit) clinical features - GENITAL
Cervical | Uterine dysplasia
56
Megaloblastic anemia (b12 and/or folate deficit) clinical features - REPRODUCTIVE
Infertility | Sterility
57
Megaloblastic anemia (b12 and/or folate deficit) clinical features PSYCHIATRIC
Depressed affect | Cognitive dysfx
58
Megaloblastic anemia (b12 ONLY) clinical features NEUROPSYCHIATRIC
``` Disrupted proprioception Neuropathic pain Paresthesia —req tuning fork —applies to B12 only ```
59
Megaloblastic anemia W/U
``` Direct B12 - folate B12 deficit -- <170 --macro-ovalocytes —hypersegs —^MMA/homocysteine Homocysteine level —^ both b12/folate MMA --^b12 only Folic acid deficit --<150 — macro-ovalocytes —hypersegs —NL MMA —^homocysteine ```
60
Other causes Macrocytic anemia
``` Chronic liver disease Etoh use D/O Myelodysplastic syndrome Hypothyroidism Pregnancy ```
61
Alcoholic use D/O effects what?
1. Direct bone marrow toxicity | 2. Interferes w/ folate metabolism
62
If a pt w/ alcoholic use D/O abstains then what happens to the macrocytosis?
resolves w/in 2-4mo if irreversible liver damage has not occured
63
Myelodysplastic syndromes are essentially?
A pre-leukemic process
64
BM D/O w/ ineffective erythropoiesis and dysplasia are due to?
Mutation in a hematopoietic stem cell
65
Peak MDS age pop?
>60yo
66
What is the etiology of MDS?
``` Idiopathic 80% 2/2 -Chemo -Radiation -Toxic substances (benzene) ```
67
MDS MCV?
>=105
68
MDS can lead to what blood cancer?
AML (30%)
69
MDS clinical findings are
Anemia - fatigue, pallor Neutropenia (Leukopenia) - (Inf risks, fever) Thrombocytopenia - (Bleeding) +-splenomegaly
70
MDS CBC criteria?
Leukopenia Anemia Thrombocytopenia =Pancytopenia
71
MDS TXT
``` Supportive Transfusions <7hgb = pRBCs <50k plt and surgery consideration = PLT's <20k plt and bleeding = PLT's <10k plt and asymptomatic -refer heme/onc or send to ED ```
72
Other Macrocytic anemia etiologies?
1. Hypothyroidism > levothyroxine > failure think pernicious anemia (both autoimmune dz) 2. Pregnancy - increased folate requirements - txt w/ folic acid supplement to pvt NTD

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