Macrocytic Anemias

Question 1

Macrocytic vs Megaloblastic

Answer 1

Macrocytic >100-115

Megaloblastic >115

Question 2

2 Megaloblastic Anemias?

Answer 2

B12 deficiency

Folic Acid Deficiency

Question 3

Common Macrocytic Anemias?

Answer 3

Reticulocytosis, liver dz, alcoholism, hypothyroid, aplastic anemia, meds

Question 4

What is left over in Reticulocytosis?

Answer 4

RNA left over in reticulocytes

Question 5

When will an alcoholic macrocytic anemia return to normal?

Answer 5

2-4 months after drinking cessation

Question 6

Combo antiretroviral therapy causes what type of anemia?

Answer 6

Macrocytic Anemia

Question 7

Who gets Aplastic Anemia? What ages?

Answer 7

East Asian.

Biphasic age distro: 10-25, 60+

Question 8

Aplastic Anemia is due to injury to what type of cell?

Answer 8

Pluripotent Stem Cell

Question 9

Aplastic Anemia does what to all 3 major blood lines?

Answer 9

Reduces their numbers.

Question 10

Do the cells look normal in Aplastic Anemia?

Answer 10

Yes they look normal, just not a lot of cells

Question 11

What type of failure is Aplastic Anemia?

Answer 11

Bone Marrow failure

Question 12

What is Fanconi Anemia?

Answer 12

DNA repair defect that can cause Aplastic Anemia

Question 13

What is Dyskeratosis Congenita?

Answer 13

Defect in maintenance of hematopoietic stem cell telomere length maintenance. Cause of Aplastic Anemia.

Question 14

Inciting Event of Aplastic Anemia?

Answer 14

Exposure which kills the hemipoietic stem cells. Takes weeks to months until pancytopenic effect is seen. WBCs die first so see infection first.

Question 15

What seen first in Aplastic Anemia?

Answer 15

Infection due to WBCs dying off

Question 16

Recurrent infections in Aplastic Anemia due to what?

Answer 16

Profound neutropenia

Question 17

Mucosal Hemorrhage in Aplastic Anemia due to what?

Answer 17

Thrombocytopenia

Question 18

Aplastic Anemia can cause what to increase in premenopausal women?

Answer 18

Increased menstural flow

Question 19

Two most common PE findings in Aplastic Anemia?

Answer 19

Pallor and Petechiae

Question 20

What does CBC show in Aplastic Anemia?

Answer 20

Pancytopenia. All cell lines low.

Question 21

Reticulocyte Index high or low in Aplastic Anemia?

Answer 21

Low

Question 22

Are cells in Aplasic Anemia normal or abnormal?

Answer 22

Normal. Just low in number.

Question 23

Tx for Aplastic Anemia if under 20 y/o?

Answer 23

Allogenic hematopoietic stem cell transplant (HCT) unless can’t get for a really good reason then use Immunosuppressive Therapy (IST)

Question 24

Tx for APlastic Anemia is over 50 y/o?

Answer 24

Allogenic hematopoietic stem cell transplant (HCT) can be considered but immunosuppressive therapy is better as it disrupts the process which kills the stems cells

Question 25

What is the most common form of congenital Aplastic Anemia?

Answer 25

Fanconi Amenia

Question 26

Etiology of Fanconi Anemia? (hint: genetic)

Answer 26

Autosomal recessive disorder causing defect in DNA repair pathway

Question 27

What is Sindactyly and seen where?

Answer 27

Fused digits seen in Fanconi Anemia

Question 28

TOC for Fanconi Anemia?

Answer 28

Allogeneic hematopoietic cell transplantation (HCT). Can | restore normal hematopoiesis.

Question 29

VitB12 and Folate deficiencies what type of cytic anemia?

Answer 29

Megaloblastic Anemia. MCV >110-115

Question 30

Which megaloblastic anemia causes neurological problems?

Answer 30

VitB12

Question 31

Segmented Neutrophils seen in what type of anemia?

Answer 31

Megaloblastic

Question 32

2 main causes of Megaloblastic Anemia?

Answer 32

Vegans who don't get enough B12 | Folate stores reduce in preggers and alcoholics

Question 33

How much B12 is needed in a day?

Answer 33

3-5mcg

Question 34

What absorbs VitB12?

Answer 34

Intrinsic Factor

Question 35

Which cell makes Intrinsic Factor?

Answer 35

Parietal Cells in stomach

Question 36

Which part of intestine is B12-IF complex absorbed in?

Answer 36

Terminal Ileum

Question 37

B12 super important for metabolism of _____ and synthesis of ____

Answer 37

Nucleic acid metabolism | Myelin synthesis

Question 38

Etiology of Pernicious Anemia?

Answer 38

Autoimmune dz destroys parietal cells and no Intrinsic Factor

Question 39

Neurologic sx of Pernicious Anemia

Answer 39

Due to B12 deficiency. Peripheral nerves affected first. Balance and propioception, altered cerebral function.

Question 40

Decreased sense of vibration, decreased positional sense, and memory disturbances due to what?

Answer 40

Vit B12 deficiency

Question 41

Serum B12 level in B12 Deficiency?

Answer 41

<170

Question 42

Does Pancytopenia occur with B12 deficiency?

Answer 42

Yes!

Question 43

Tx for B12 deficiency?

Answer 43

Vitamin B12 100mcg SC or IM - daily x 1 week, then weekly x 1 month, then monthly for life

Question 44

Folic Acid is critial in the synthesis of what?

Answer 44

DNA synthesis

Question 45

Most common cause of Folic Acid Deficiency?

Answer 45

Inadequate intake

Question 46

Folic Acid found in what foods?

Answer 46

Fruits and veggies

Question 47

Can alcoholism cause Folic Acid Deficiency?

Answer 47

Yes!

Question 48

Does Folic Acid Deficiency have neurological sx?

Answer 48

NO

Question 49

RBC folic acid level below what in Folic Acid Deficiency?

Answer 49

<150

Question 50

Tx for Folic Acid Deficiency?

Answer 50

Folic acid 1 mg PO daily for 1-4 months or hematologic recovery

Question 51

What else to check in suspected Folic Acid Deficiency?

Answer 51

Check for concomitant B12 deficiency

Question 52

Where is Folic Acid absorbed?

Answer 52

Throughout GI tract (duodenum and jejunum)

Question 53

Body stores of B12 last how long? Folate?

Answer 53

B12=3 years | Folate=2-3 months

Question 54

Positive Schilling Test in which megaloblastic anemia?

Answer 54

Pernicious Anemia