Escolar Documentos
Profissional Documentos
Cultura Documentos
Megaloblastic Anaemia
Megaloblastic anaemias are characterized by delayed maturation of the nucleus of RBCs in the
bone marrow due to defective DNA synthesis. These cells either die in the marrow or enter the
bloodstream as enlarged, misshapen cells with a reduced survival time.
Both folate and vitamin B12 are necessary for the synthesis of DNA
Red cells are enlarged and egg-shaped and the neutrophils hypersegmented due to retention of
surplus nuclear material
Clinical features include: jaundice, glossitis, angular stomitis, weight loss and
macrocytosis
N2O anaesthesia reversibly inactivates body B12, and prolonged or repeated exposure
may cause megaloblastic anaemia or B12 neuropathy.
Congenital enzyme deficiencies causing errors in DNA synthesis, e.g. orotic aciduria
Vit B12
Structure:
Consists of a small group of cobalamins with a cobalt atom at the center of a corrin
ring.
Forms:
1) Methyl B12- methyl cobalamin (human plasma)
2) Ado B12- deoxyadenosylcobalamin (human tissues)
3) Hydroxo B12- hydroxocobalamin (treatment)
2) Gastric causes:
Atrophic gastritis
Malabsorption
3) Intestinal causes:
Ileal resection
Crohns disease
Proteinuria
Fish tapeworm
Treatment:
Then one injection every 3 months (for life if patient has total gastrectomy or ileal
resection)
Diet history
Intestinal malabsorption
tests for intrinsic factor (IF), antibody (positive in 50% of cases of PA) and
parietal cell antibodies (positive in 90% of cases of PA)
FOLATE
Causes of Folate deficiency:
Dietary insufficiency
Excessive utilization: increased cell turnover and DNA synthesis causes breakdown of
folates. The most common causes include pregnancy (folate decreases with increased
DNA synthesis), haemolytic anaemia and malignant diseases (lymphoma, myeloma,
carcinoma)
Excess urinary folate loss: Folate is loosely bound to protein in plasma and is easily
removed by dialysis (chronic dialysis), congestive heart failure, active liver disease
Treatment:
This is given for 4 months at least, the precise duration of therapy depending on the
underlying cause/disease
Diet history
Intestinal malabsorption
Duodenal biopsy