Ipapburke Hematology Test 1- Macrocytic

Front 1

MCV in Macrocytic anemias

Back 1

>100

Front 2

Basic mechanism of macrocytic anemias

Back 2

related to cell formation disruption

Front 3

What do hypersegmented neutrophils and macro-ovalocytes suggest?

Back 3

megaloblastic anemia

Front 4

In the absence of nutritional or drug induced macrocytic cause, an MCV around 100 suggests what causes?

Back 4

hypothyroidism, pregnancy, liver dz, alcohol abuse

Front 5

In the absence of nutritional or drug induced macrocytic cause, an MCV more than 105 suggests what causes?

Back 5

bone marrow d/o

Front 6

The term megaloblastic refers to what?

Back 6

large atypical erythroblasts that develop in association with abnormal DNA synthesis

Front 7

MC cause of megaloblastic anemia

Back 7

nutrition deficiencies of B12 or folate

Front 8

Causes of B12 deficiency (6)

Back 8

pure dietary def. (rare), decreases intrinsic factor, H Pylori infection, competition for B12 due to bacterial overgrowth, decreased ileal absorption, pancreatic insufficiency

Front 9

autoimmune disease with antibodies to gastric parietal cells as well as intrinsic factor

Back 9

pernicious anemia

Front 10

Predominant group affected by pernicious anemia

Back 10

Caucasians (strong hereditary component)

Front 11

Diagnosis of pernicious anemia confirmed by?

Back 11

B12 deficiency with normal folate and presence of typical antibodies

Front 12

source of folate

Back 12

plant matter

Front 13

Where is folate absorbed?

Back 13

throughout small intestine

Front 14

What is enterohepatic recirculation?

Front 15

Drugs that may cause macrocytic anemia (2)

Back 15

hydroxyurea, methotrexate

Front 16

What characterized cobalamin deficiency?

Back 16

elevations in the serum levels of homocysteine and MMA

Front 17

Describe pathophysiology of B-12 deficiency.

Back 17

Purine synthesis disturbed --> DNA synthesis disturbed --> abnormal erythropoiesis

Front 18

What explains the presence of hypersegmented neutrophils in B-12 deficiency?

Back 18

asynchronous cellular nuclear and cytoplasm maturation leads to excess cytoplasm and the abnormal nuclei

Front 19

Why might there be a delayed onset of anemia from B-12 deficiency?

Back 19

there is a high ratio of storage to use so it may take years to develop

Front 20

Two conditions that can cause decreased intrinsic factor

Back 20

gastrectomy and pernicious anemia

Front 21

Two possible causes of decreased ileal absorption

Back 21

surgical resection and Crohn’s disease

Front 22

Lab results in folate deficiency

Back 22

normal MMA and abnormal homocysteine

Front 23

Why does folate deficiency anemia develop more quickly than B12?

Back 23

Because folate usage is greater even though stores are about the same (weeks to months to develop)

Front 24

Causes of Folate Deficiency (3)

Back 24

nutritional (decreased dietary intake, dual deficiency created by alcohol), increased requirements (physiologic like pregnancy or pathologic like hemolytic anemia), and malabsorptive causes (abnormal intestinal mucosa- i.e. Sprue or normal intestinal mucosa in congenital d/o)

Front 25

How does alcohol create a “dual deficiency” in folate deficiency?

Back 25

interferes with initial absorption as well as enterohepatic circulation

Front 26

Drugs that effect folate absorption or disrupt its metabolism.

Back 26

alcohol, methotrexate, sulfasalazine, triamterene, pyrimethamine, trimethoprim, phenytoin, barbituates, hydroxyurea

Front 27

Three drugs that can cause drug induced macrocytic anemia with or without interfering with folate

Back 27

Alcohol, methotrexate, and hydroxyurea

Front 28

Manifestation of megaloblastic anemia in hematologic system

Back 28

macrocytic anemia leading to pancytopenia with megaloblastic marrow

Front 29

Manifestation of megaloblastic anemia in the cardiopulmonary system

Back 29

congestive heart failure

Front 30

Manifestation of megaloblastic anemia in gastrointestinal system

Back 30

macroglossitis, malabsorption syndromes

Front 31

Manifestation of megaloblastic anemia in dermatologic system

Back 31

melanin pigmentation and premature aging

Front 32

Manifestation of megaloblastic anemia in genital system

Back 32

cervical and uterine dysplasia

Front 33

Manifestation of megaloblastic anemia in reproductive system

Back 33

infertility or sterility

Front 34

Manifestation of megaloblastic anemia in psychiatric system

Back 34

depressed affect and cognitive dysfunction

Front 35

Manifestation of megaloblastic anemia in neuropsychiatric system (B12)

Back 35

disruption of proprioception, neuropathic pain, and parasthesias

Front 36

Homocysteine level in b12 deficiency

Back 36

elevated

Front 37

Homocysteine level in folate deficiency

Back 37

elevated

Front 38

MMA level in B12 deficiency

Back 38

elevated

Front 39

MMA level in folate deficiency

Back 39

normal

Front 40

In pernicious anemia, B12 replacement must be done ________.

Back 40

intravenously

Front 41

How long does it take for hypersegmented neutrophils to disappear after beginning treatment for megaloblastic anemia?

Back 41

10-14 days

Front 42

What is the typical dose for B12 deficiency (when neurologic dysfunction is not suspected)?

Back 42

1000 mcg monthly; if neurologic damage- daily or weekly therapy

Front 43

Typical treatment for folate deficiency.

Back 43

oral replacement of 1 mg daily

Front 44

Explain chronic liver disease as a cause of macrocytic anemia.

Back 44

processes that impair hepatic function impair lipid metabolism; excess lipids are deposited in RBC lipid bilayer- result in increased size and thus macrocytosis

Front 45

Etiology of alcoholic macrocytic anemia

Back 45

direct bone marrow toxicity; abnormal RBC lipid metabolism; interference with folate metabolism

Front 46

What are myelodysplastic syndromes?

Back 46

heterogenous bone marrow disorders characterized by ineffective blood cell production

Front 47

Etiology of primary myelodysplastic syndromes (MDS)

Back 47

idiopathic

Front 48

Known causes of secondary MDS

Back 48

prior treatment or exposures to chemo, radiation, or toxic substances like benzene

Front 49

Clinical hematologic features of MDS

Back 49

macrocytic anemia with MCV usually over 105; cytopenias in other cell lines (WBCs and platelets), monocytosis (only in CMML)

Front 50

Patients with MDS are at increased risk of developing what?

Back 50

acute myelogenous leukemia--considered pre-leukemia or neoplastic anemia

Front 51

Diagnosis of MDS

Back 51

bone marrow biopsy with expert hematopathologist intepretation

Front 52

Possible treatments for MDS (although there is no single effective therapy) (5)

Back 52

1. transfusion of RBCs and platelets 2. hematologic stimulating factors 3. Bone marrow transplant 4. experimental chemo or immunosuppression

Front 53

RBC hematologic stimulating factors

Back 53

Procrit or Aranesp

Front 54

WBC hematologic stimulating factors

Back 54

Neupogen or Neulastia

Front 55

Describe macrocytic anemia caused by hypothyroidism

Back 55

mild anemia related to relative erythrocyte hypoproliferation as a result of reduced metabolism

Front 56

Why might mild macrocytic anemia be present in pregnancy?

Back 56

increased folate requirements during pregnancy

Front 57

What is marked reticulocytosis?

Back 57

macrocytic anemia in which the MCV spuriously increases due to excessive reticulocytes (larger than RBCs); transiently seen in patients with massive hemolysis without coexisting microcytic processes