RBC Disorders Megaloblastic Anemia

"Strength does not come from winning. Your struggles develop your strength. When you go through hardship and decide not to surrender, that is strength." Arnold Schwarzenegger Bodybuilder and Actor HEMATOLOGY: RBC Disorders Dr. VM Shashidhar Senior Lecturer in Pathology Fiji School of Medicine Blood Smear - Normal White Blood Cells: Megaloblastic anemia: • Vitamin B12/Folic acid deficiency • Low DNA synthesis – Nuclear immaturity - less division – more cell size - Macrocytosis • Megaloblasts – Abnormal – destruction - RBC • DNA defect – all cell lines affected -pancytopenia • Multi System disease – cell division - Epithelia. • Pernicious anaemia – autoimmune, VitB12 absorption deficiency - Gastric atrophy – CNS damage. Megaloblastic anemia: • Vitamin B12/Folic acid deficiency • Second most common type of anemia. • Vit B12 Synthesised only by microorganisms – animal food & dairy Pr • Folate only in Plant foods – uncooked. • Vegetarianism ..? Megaloblastic Anemia : Megalobl - Pathogenesis: • • • • • • • • Decreased Vit B12 / Folate Decreased DNA Synthesis Delayed maturation of erythroblasts (Nucleus) Increased cell size (macrocytes) Normal hb content (Normochromia) Decreased RBC number Decreased WBC number (pancytopenia) Anemia & Pancytopenia. Macrocytic Anemia (Meg.): Megaloblastic Anemia : Megaloblastic Anemia : Megaloblastic Anemia : CWM-20353-Meg.An CWM-20353-Meg.An Clinical Case: • History: – A 48 year old male has become progressively more fatigued at the end of the day. This has been going on for months. In the past month he has noted paresthesias with numbness in his hands. A CBC demonstrates the findings shown below. A peripheral blood smear (the slide is representative of this condition) shows red blood cells displaying macro-ovalocytosis and neutrophils with hypersegmentation. CBC Result Blood Film: Quiz: • • • • Describe RBC Morphology. - M/N, OM, HSP, APC Describe The WBC in the field. What is the diagnosis from these findings? MBA Which of the following tests would be most useful to determine the etiology: – – – – – A. Hemoglobin electrophoresis – Cong hemolytic anemia B. Reticulocyte count – Hemolytic anemia C. Stool for occult blood - parasites D. Vitamin B12 assay - MBA E. Bone marrow biopsy - Malignancy Schilling test • Radiometric test of cobalamin absorption. (3 parts) • First - radioactive cyanocobalamin is given orally. Unlabeled cyanocobalamin is given intramuscularly • Next, the urinary secretion of radioactive cobalamin is measured . • Second - test is performed in the same manner, except that IF is given orally along with radioactive cyanocobalamin. • Third - Patient is treated with antibiotics prior. (Blindloop syndrome) • Problem: Inadequate collection of urine samples Folate Estimation: • Serum folate is low - folate deficiency during the previous 2-3 days. A single meal with normal folate content can change to normal. • The RBC folate level is usually low in patients with folate deficiency and levels do not fluctuate during the lifespan of the RBC. • The RBC folate level may not be low in persons with rapidly developing acute folate deficiency. • RBC folate levels are low in more than 50% of patients with cobalamin deficiency. People can be divided into two classes: those who go ahead and do something, and those who sit still and inquire, 'Why wasn't it done the other way? - Oliver Wendell Holmes