Megaloblastic anemia

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Megaloblastic anemia

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NOTES NOTES MACROCYTIC ANEMIA GENERALLY, WHAT IS IT? PATHOLOGY & CAUSES ▪ Bone marrow produces larger than normal erythrocytes AKA red blood cells (RBCs) CAUSES ▪ Multifactorial: nutritional deﬁcits, genetics, substance exposure (e.g. certain drugs, alcohol) SIGNS & SYMPTOMS ▪ Fatigue, dyspnea, weight loss, pallor, impaired concentration/memory, diarrhea, onychoschizia (brittle nails) DIAGNOSIS LAB RESULTS ▪ ▪ ▪ ▪ ▪ Complete blood count Peripheral blood smear analysis Blood chemistry Iron studies Genetic testing TREATMENT ▪ Address underlying causes MEGALOBLASTIC ANEMIA osms.it/megaloblastic-anemia PATHOLOGY & CAUSES ▪ Macrocytic, normochromic anemia characterized by formation of large RBCs CAUSES Cobalamin and/or folate deﬁciency ▪ Impaired DNA synthesis during erythropoiesis → uncoordinated maturation of cytoplasm and nuclei in erythroblasts (nuclear-cytoplasmic asynchrony) → abnormally large RBCs (macrocytosis) + defective cells with fragile membranes → RBCs die prematurely → anemia B12 deﬁciency ▪ Insufﬁcient diet (e.g. vegan diet without B12 supplements, alcoholism, systemic/mental illness, food insecurity) ▪ Malabsorption ▫ Lack of intrinsic factor → pernicious anemia ▫ Surgical: gastrectomy, bariatric surgery → lack of absorptive surface → pernicious anemia ▫ Pancreatic insufﬁciency → impaired binding of B12 to intrinsic factor → pernicious anemia ▫ Medications that interfere with absorption: e.g. biguanides, H2 receptor blockers, proton-pump inhibitors, neomycin OSMOSIS.ORG 409

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Megaloblastic anemia

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A 35-year-old woman presents to her provider’s office for evaluation of fatigue and exercise intolerance that began two months ago. Past medical history is notable for Crohn disease diagnosed eight-years ago. She is taking mesalamine but reports frequent “flare-ups.” The patient consumes 3-4 glasses of wine per week. Her temperature is 36.9°C (98.4°F), blood pressure is 123/76 mmHg, pulse is 75/min, and respiratory rate is 12/min. The patient has conjunctival pallor. Cardiac, pulmonary, and abdominal examinations are non-contributory. Neurological examination reveals decreased proprioception and vibratory sensation in the lower extremities. Complete blood count reveals a hemoglobin of 8.8 g/dL and a mean corpuscular volume (MCV) of 115 µm3. Which of the following findings would be most likely present in this patient?

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