Macrocytic Anemia PDF

MACROCYTIC ANEMIA The answer will be based on the article ‘Diagnosing and treatment of macrocytic anemia in adults’ Nagao et al, 2016  Characteristic Anemia Hb – Male ( < 13g/h) Female (...

MACROCYTIC ANEMIA The answer will be based on the article ‘Diagnosing and treatment of macrocytic anemia in adults’ Nagao et al, 2016  Characteristic Anemia Hb – Male ( < 13g/h) Female (< 1g/L) MCV – > - 100 f L Student 1  Etiology of Macrocytic Anemia Divided into 2 : Loading… __________________________ Megaloblastic ________________ Deficiency/impairment of utilization of vitamin 1312 _________________ of utilization folate Deficiency/impairment ___________________________ Non-Megaloblastic ___________________ Liver dysfunction Some · drug ____________________ Alcoholisin Usage Myelodysplastic syndrome (MDS) ____________________ Student 2 Hypothyroidism ____________________  Megaloblastic Anemia Vitamin B12 deficiency Sources : ___________________ Meat fish 3 dairy products , , eggs Also known as : ______________ pernicious anemic Function of B12 : ????? RBC - formation , DNA synthesis , maintain neurological function Causes : _______________ Dietary deficiency _______________ Malabsorption _______________ Congenital disorders Student 3 _______________ Gastrectomy  Vitamin B12 absorption intrinsic factor Vitamin ________bind B12 to IF secreted by gastric parietal - cells Loading… Absorbed in ________________ terminal ileum Once absorb vit B12 act as _________ coenzyme to produce ______________ methionine (from homocysteine) Finally folic acid convert to _______________ its active form Impair DNA synthesis ↳ 5-methyltetrahydrofolate Student 4  Sign and Symptom Sign and symptoms: ________________________________ Fatigue ________________________________ Headache ________________________________ palpitations _________________________________ Dyspnea _________________________________ Gray hair · Neurological Symptoms (dysesthesia hypoesthesia) , Student 5  Peripheral Blood Microscopic Observation presence of neutrophils lobes _________________ Hypersegmented neutrophil with six or more _________________ Macro-ovalocytes _________________ Anisocytosis Bone Marrow Biopsy ____________________ Hyper cellularity with abnormal maturation _____________________ Proliferation of myeloid cell lines Student 6  Blood Smear Hypersegmented RBC Macrocytosis  Laboratory Findings Biochemical Result (evidence of hemolysis) High level of LDH (Lactate dehydrogenase) ____________________ _____________________ High level of indirect bilirubin ______________________ Decrease level of haptoglobin - why ? Treatment – _________________________________________ Treated with parenteral administration of vitamin _________________________________________ B12 , and hematological levels return to normal within one month.  Megaloblastic Anemia Pernicious Characteristic Anemia ________________________ Lack of intrinsic factor ________________________ Destruction of gastric parietal cell ________________________ detected Antigastric parietal cell autoantibodies Treatment : __________________________ lifelong administration of Vitamin B12 , intramuscular injection and high oral closes of vitamin B12. Student 7 Pernicious anemia Loading…  Megaloblastic Anemia Folate Deficiency Folate is also known as ____________________ Folic Acid Folacin or Sources : __________________ Green vegetables 3 Animal products Absorbed in ______________ Upper Jejunum via passive and active diffusion. Treatment : Causes: · Oral Folic Acid for ______________ Nutritional deficiency Nutritional Deficiency ______________ Malabsorption ______________ Medication Student 8 ______________ Increased requirements in certain cases  Treatment: ____________________  Non-megaloblastic Anemia Alcoholism MCV : _____________ 100-110 fL Diagnose by : (sensitives to detect alcoholism in macrocytosis) ________________________ Michigan Alcoholism Screening Test ________________________ Y-glutamyltransferase Level Student 9  Non-megaloblastic Anemia Hypothyroidism Thyroid hormone stimulate _____________ production of erythropoietin _____________ Affects the hematopoiesis So, reduction of this hormone will cause anemia Student 10  Non-megaloblastic Anemia Drugs Interference of absorption, plasma transport, delivery of ___________ folate or __________ Vitamin 12 Hydroxyurea, Methotrexate, Zidovudine… Student 11  Differential diagnosis If MCV high, check on: B12 deficiency if serum B12 < ______ 200 pg/mL Folate deficiency if serum folate < ______ 2 ng/mL B12 (200-300), check on Methyl malonic Acid (what this acid do? How is the relationship between B12) Homocysteine (B12 need to convert homocysteine to methionine so when B12 low, high homocysteine) 3 elevated both in B12 and folate deficiency Student 12  Differential diagnosis If both B12, folate normal check on reticulocyte, High = Hemolysis/Blood Loss Low = Alcoholism, Hypothyroidism, MDS, Liver Disease Biochemical test done to exclude hemolysis ___________________________ Lactate dehydrogenase ____________________________ Indirect bilirubin ____________________________ Haptoglobin Student 13  Calculate the MCV and what is the diagnosis? 1) Hct : 40%, RBC : 3.5x106 cell/uL 2) Hct: 35%, RBC : 5.0x106 cell/uL 3) Hct: 40% , RBC : 5.0x106 cell/uL DMCV 114fL diagnosis Macrocytic = , = anemia anemic 2) MCV = 70fL , diagnosis = Microcytic anemia 3) MCV = 80fh , diagnosis = Nomocytic (Student 14,15,16) Calculate the Red Cell Indices Hb 12.5 MCV = 100th Hct 42% MCH = 29. 84) RBC 4.2 MCHC : 29. 8 gld :. Nomocytic anemia Hb 12.5 MCV = 102 fl Hct 42% MCH 48p3 = 30. RBC 4.1 MCHC 29 76 g/dL :. - Macrocytic anemia Hb 12.5 MCV = 88 1 f. Hct 37 % MCH = 29 76 Pg RBC 4.2. MCHC = 33 78. g/d) (Student 17, 18, 19) : Nomocytic anemic