Week 4: Macrocytic Anemia

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Macrocytosis Vitamin B12 Folic acid Megaloblastic changes Pernicious anemia Schilling test Hypersegmented PMN

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Bone marrow analysis WBC precursors Liver disease Polycythemia and erythremia PV Newborn CBC

Bone Marrow Analysis
Aspirate  Particles in fluid part of marrow  Differential count  Biopsy  Solid part of the marrow  Cellularity  Clot section

Aspiration Biopsy .

stab Segmented neutrophil. PMN .WBC Precursors       Myeloblast Promyelocyte  Primary azurophilic granules Meylocyte  Specific granules Metamyelocyte Band.

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Myeloblast Promyelocyte Neutrophilic Myelocyte .

Segmented neutrophil and lymphocyte .

Mast cell and histiocyte Mast cell Megakaryocyte Plasma cell .

Histiocyte Fat cell Macrophage .

Osteoclasts Osteoblasts Giant cell .

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Non-Megaloblastic Macrocytosis Alcoholism  Poor nutrition  Cirrhosis  Liver disease  Reticulocytosis  Hemolytic anemia  Hemorrhage  .

Megaloblastic Anemia Hemolytic changes  Waxy pallor  Neurologic changes with B12 deficiency  Glossitis. beefy red or smooth pale tongue  .

Causes of Megaloblastic Anemia    Folate deficiency  Dietary (green leafy vegetables)  Malabsorption B12 deficiency  Dietary  Fish tapeworm (D latum) Pernicious anemia  Lack of gastric intrinsic factor (IF) for absorption .

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no need for IV) .B12 Metabolism     Bind to cobalophilin (cobalamine binding protein) in saliva and gastric secretion Bind to IF (from parietal cell) in the duodenum Cbl-IF complex bind to receptor (cubilin) at distal ileum for mucosal absorption 1% B12 can be absorbed without IF (megadose of B12 for IF deficiency.

Autoimmune mechanism for PA .

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Megaloblastic Lab Changes      MCV up to 140 fL Howell-Jolly bodies and Cabot rings Hypersegmented PMN Pancytopenia BM with low M:E ratio      Megaloblastic morphology (giant bands and metas) B12 and folate assays RBC folate (long term indicator) IF antibody (PA) Schilling test (obsolete) .

Hypersegmented PMN Megaloblastic anemia Megaloblastic BM .

Other Apparent Macrocytoses Cold agglutinin  Prewarm samples  Hyperglycemia  Osmotic changes  Clot  Rouleaux  .

Polycythemia Vera A type of myeloproliferative disorder (MPD)  Independent of EPO  High total RBC mass (by radio tagging)  .

Secondary Polycythemia Dehydration (decreased plasma volume)  Increased O2 demand (e.g. kidney tumor)  .g.. emphysema.. high elevation)  High EPO (e.