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Megaloblastic and Non-megaloblastic Macrocytic Anemia
Terms in this set (19)
Megaloblastic Anemia: Cause
-Abnormal DNA maturation
-Delayed nuclear maturation that impairs cell division
-Nuclear cytoplasm asynchrony
What is nuclear cytoplasm asynchrony?
Where the nucleus appear immature with fine particulate chromatin pattern, incerased, more mature cytoplasm. All proliferating cells are affected.
Non-Megaloblastic Anemia: Cause
-Increase in membrane lipids
Why does abnormal DNA maturation cause a problem?
-Impairs production of thymidine nucleotide
-DNA replication remains incomplete
-Limits cell division (why large cells are seen)
-Accumulation of 5-methyltetrahydrofolate
-Accumulation of homocysteine
What is the most common cause for megaloblastic anemia? Why?
Folic acid deficiency and B12 (cobalamin) deficiency
These vitamins are necessary as coenzymes for nucleic acid synthesis
What are the clinical findings in Megaloblastic anemia?
Few symptoms at first since anemia develops slowly.
-shortness of breath
Glossitis- loss of epithelium on tongue (beefy red tongue, smooth pale tongue)
What are the clinical findings in B12 deficiency?
-Demyelinization of spinal cord (memory loss, numbness, tingling, loss of balance, depression, psychosis
-Neural tube defect (spina bifida)
What are the common laboratory in megaloblastic anemia?
-ovalocytes, howell-jolly bodies, polychromasia
-Increased serum bilirubin
What are the additional significant laboratory findings w/ folate deficiency?
-Decreased serum folate
What are the additional significant laboratory findings w/ B12 deficiency?
-Decreased serum cobalamin (B12)
What are the common laboratory in non-megaloblastic anemia?
-Polychromasia, target cells, stomatocytes, schistocytes
What would you find in the bone marrow in megaloblastic anemia?
-Hypercellular w/ megaloblastic erythroid precursors
-Decreased M:E ratio
-Giant metamyelocytes, megakaryocytes
What is the cause of Folate deficiency?
-Nutritional (not enough, increased need, impaired absorption, alcoholism)
-Impaired utilization-drug interaction
-Excessive loss (renal dialysis)
What is the cause of B12 deficiency?
-Nutritional (not enough, increased need, impaired absorption)
-Impaired absorption (intrinsic factor deficiency, autoantibodies, gastric parietal cells) Pernicous Anemia
-Inflammatory bowel disease
-Diphyllabothrium latum infestation
What are the laboratory findings for diagnosis?
-Increased bilirubin and LD (due to intramedullary death of RBC's and ineffective erythropoiesis-no elevation of retic)
-Increase in intermediates in folate and B12 metabolism
-Methylmalonic Acid MMA (B12 deficiency)
-Formiminoglutamic acid FIGLU (folic acid deficiency)
-Increase in homocysteine levels
-RBC folate and serum folate levels
-Bone marrow biopsy (hypercellular and megaloblasts)
Abnormalities in ineffective erythropoiesis:
-Intense marrow erythropoietic activity
-Marrow erythroblast destruction
-Increased marrow phagocytic activity
-Anemia w/ low red cell count
-Elevated LD and nucleic acids
-Elevated total and indirect bilirubin
Macrocytic anemia w/o megaloblastosis:
-Usually round not oval
-large cells due to increase membrane lipids
-Toxic effect of ethanol on erythroblast
-RBC precursors may be vacuolated
-Due to alcoholism, hepatitis, obstructive jaundice
-Shortened RBC survival (hemolysis)
-Increased membrane lipids
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