- defective DNA synthesis
- majority resulting from deficiency in cobalamin (B12) required for RBC formation, and folic acid
-megaloblastic anemias
- intrinsic factor is not secreted and cobalamin is not absorbed
- commonly causes pernicious anemia: absent IF, insidious onset, middle age, AA
- can also occur: GI surgery, chronic diseases, excessive alcohol and hot tea, smoking, long term H2 histamine receptor blockers, PPIs, and strict vegetarians
- manifestations develop slowly due to hypoxia, beefy, red, sore, tongue. weakness and paresthesia of feet and hands, impaired thought process
- RBCs have fragile cell membranes and abnormal shapes
- low cobalamin levels
Megaloblastic Anemias-Cobalamin deficiency
What is the treatment for Megaloblastic Anemias-Cobalamin deficiency?
parenteral or intranasal cobalamin (vit B12)
- pt’s will die in 1-3 years without tx
- can be reversed but longstanding complications may not be reversible
- clinical manifestations similar to cobalamin deficiency
- commonly caused by alcohol abuse (malabsorption and dietary deficiency), dietary, malabsorption, drugs, anorexia
- decreased sesation to heat and pain from neurological impairment
megaloblastic folic acid deficiency anemia
What differentiates folic acid vs cobalamin (B12) megaloblastic anemia?
absence of neurologic problems with folic acid deficiency
What lab will differentiate between the 2 megaloblastic anemias?
-folic acid level
va
-B12 level
What is the Tx for megaloblastic folic acid deficiency anemia?
- replacement therapy
- 1mg/day folic acid
- foods high in folic acid
- underproduction of RBCs
- shortening of RBC survival
- normocytic, normochromic, and hypo proliferative RBCs
- usually mild but can be severe if untreated
- can be caused by kidney failure w/out dialysis
- increased ferritin and iron stores
- normal folate and cobalamin levels
- treat underlying cause
- Eopoetin alfa IV or SQ
anemia of chronic diseases: anemia of inflammation
- pancytopenia: decrease in all blood cell types (RBC, WBC, and platelets)
- hypocellular bone marrow (not producing)
- ranges from chronic to critical
- rare, abrupt or gradual
- acquired, idiopathic, autoimmune
- symptoms are caused by suppression of any or all bone marrow
- manifestations: fatigue, dyspnea, cardiovascular, cerebral, neutropenia, septic shock, death, thrombocytopenia, petechiae, more yellow marrow (fat) than red
- Labs: low Hgb, WBC, platelet, reticulocyte, elevated iron and TIBC
aplastic anemia
What is the worst type of anemia you can have?
aplastic anemia
What is the management of aplastic anemia?
- remove causative agent
- supportive care
- prevent hemorrhage
- immune therapies and bone marrow transplantation can be curative
