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macrocytic anemias

FAB, folate deficeincy, alcoholism, b12-deficeincy

folate deficiency cause

inadequate intake, alcoholics, elderly, intestine ds, meds like methroxate

The patient is an old alcoholic male, with low serum folic acid, high LDH, Smear show macroovalocytes what the TX

Give folic acid , for folic deficiency

*For folic deficiency TX, large doses of pheytoin may cause

increase frequency of seizures

A chronic alcoholic patient, AST>ALT, smear shows: Stomatocytes and Target cells, tx

Abstinence from alcohol and nutritional counseling. B12 or folic acid given if needed

Most B12 is stored in the liver, 1-10 mg,

which is a sufficient amount to support erythropoiesis for 2-5 years.*

B12 Deficiency: also known as

megaloblastic anemia.

patient has bilateral paresthesia of hands and feet. slowed reflexes.loss of memory/confusion.*Glossitis: beefy red tongue *

B-12 Deficiency

Pernicious Anemia

the most common cause of adult B12 deficiency. autoimmune where an anti-intrinsic factor antibody attacks the parietal cell which decreases transport of B12.

Pancreatitis: (B12 deficiency)

inflammation of the pancreas decreases release of intrinsic factor.*

Schilling test < 7% excretion:,
Hypersegmented neutrophils
, MCV > 100, macroovalocytes
what tx

megaloblastic anemia, depends on Shilling test but other causes respond to Intramuscular injection of 1000 micrograms of Cyanocobolamin weekly for 4-6 weeks, then monthly for life.

Schilling Test,
STAGE B12 ↓ excretion STAGE 2 B12/IF ↑ excretion STAGE 3 AFTER ABX N/A

Pernicious Anemia , Gastric Atrophy

Schilling Test,STAGE 1 B12↓ excretion, STAGE 2 B12/IF, STAGE 3 ABX ↓ excretion ↑

Bacterial Overgrowth excretion
Diphyllobothriasis

Schilling Test, ALL 3 STAGES DECREASE EXCRETION

Terminal Ileum , Disease (Crohn's)

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