The attached image compares a marrow aspirate from a normal individual with the BM aspirate from an individual with the condition described below:
Pallor, lemon yellow tinged skin
beefy red tongue
PS: hypersegmented neutrophils
What are the 3 key BM findings in this condition?
1. Nuclear cytoplasmic dysynchrony - cytoplasmic differentiation, as assessed by increasing hemoglobin production, is normal, nuclear maturation is retarded
2. markedly hypercellular
3. giant metamyelocytes and band forms
1.2 features of anemia of chronic renal failure on a peripheral smear
2. Why do they develop anemia?
1. normocytic anemia,presence of burr cells
2. diminished synthesis of EPO
peripheral pancytopenia (decreased RBCs, WBCs, platelets)
reticulocyte index <2
What features on a peripheral smear are characteristic of myelophthisic anemia?
abnormal release of nucleated erythroid precursors and immature granulocytic forms ka leukoerythroblastic reaction
two important biochemical reactions requiring Vitamin B12
1. conversion of methylmalonyl-coenzyme A (CoA) to succinyl-CoA
2. conversion of homocysteine to methionine.
autoimmune disorder characterized by the destruction of gastric parietal cells
1. What are the 2 types of antobodies produced?
2. How does this disorder lead to megaloblastic anemia?
1. Antibodies against parietal cells and antibodies against intrinsic factor
2. Parietal cells are the source of IF. Without intrinsic factor, food cobalamin cannot be absorbed in the distal ileum
Time duration before a reticulocyte repsonse is observed in acute blood loss?
Differentiate folic acid versus Vit B 12 deificiency
decreased folate levels in the serum or red cells.
serum homocysteine levels are increased, but methylmalonate concentrations are normal
neurologic changes do not occur.
List 4 causes for Vitamin B12 deficiency apart from decreased intake.
b. ileal resection/disease
c. fish tapeworm infestation
d. bacterial overgrowth in blind loops and bowel diverticula
How does methotrexate cause folic acid deficiency?
Inhibits dihydrofolate reductase
most common cause for folic acid deficiency
Lab findings in Vit B12 deficiency apart from PS and BM
low serum vitamin B12 <200pg/ml
elevated serum levels of homocysteine
Elevated methyl malonic acid
MCV >110 fL
Why do you get a slight increase in the level of nonconjugated bilirubin in the serum and a marked increase in serum lactate dehydrogenase (LDH) in megaloblastic anemia?
increased rate of apoptosis of erythroid precursor cells due to derangement in DNA synthesis
Stomach morphology in pernicious anemia
Fundic gland atrophy
features of megaloblastic anemia on peripheral smear
Neutrophils are larger than normal and show nuclear hypersegmentation, having five or more nuclear lobules instead of the normal three to four
reticulocyte count is low
1. In whom does Parvovirus B19 infection trigger an aplastic crisis?
2. How does it trigger an aplastic crisis?
1. In persons with moderate to severe hemolytic anemias, even a brief cessation of erythropoiesis results in rapid worsening of the anemia, producing an aplastic crisis.
2. attaches to P antigen on the RBC membrane and destroys red cell progenitors
Name the type of anemia described below:
space-occupying lesions replace normal marrow elements
2 possible causes for myelophthisic anemia
1.metastatic cancer- breast, lung, and prostate
1. 3 Signs of Subacute combined degeneration of the Spinal Cord
2. What is the reason for demyelination?
1. posterior column (PC) - loss of vibratory sensation and proprioception (joint sense).
lateral corticospinal tract (LCST) - spasticity.
dorsal spinocerebellar tract (DSCT) - ataxia.
2. lack of methyl-B12 for conversion of homocysteine to methionine. ↓SAM → ↓methyl group for Phosphatidylethanolamine conversion to Phosphatidylcholine for incorporation into myelin