MACROCYTIC ANIMEA

MACROCYTIC ANIMEA

HIGH

MCV:

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The peripheral red cells are large.

A group of anemias the erythroblasts present in the bone marrow with delayed nuclear maturation because of defective DNA synthesis that could also affect the white cells leads to hypersegmentd neutrophils and leucopenia.

The most common reasone: vitamin

B 9-12 DEFICIENCY

Both of them necessary for DNA syntheses
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Vitamin B12 deficiency:

Vitamin B12 is obtained from fish-red and other meats- milk - eggs …. from animal sources.

B12 is formed from protein complexes in food and binds to one factor that secreted from parietal cells in stomach.

B12 is absorbed in terminal ileum and transported to organism by transcobalamin I - II

CARRIER PROTEINS.

B12 is stored in the liver and is sufficient supply for two years.
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CAUSES OF VITAMIN

B12 DEFICIENCY:

Low B12 intake.

Vegetarian.

Impaired absorption:

Pernicious anemia.

Gastrectomy.

Small bowel disease and malabsorption:

Tropical spure.

Celiac disease.

Infection overgrowth.

Pancreatic disorder.

 Chronic pancreatitis.

……………………….

One of the reason of B12 deficiency is pernicious anemia

What is this kind of anemia?

What age has affected?

And what is the pathology?

It is an autoimmune disease associated with atrophy of gastric mucosa and failure of intrinsic factor production.  

 This disease affects elderly people over the age of sixty years old and it's common more in women with fair hair and blue eyes.

occurs with other autoimmune disease association like hypothyroidism.

The pathological reason of pernicious anemia is the sever atrophic gastritis that lead to absent of gastric acid and intrinsic factor secretion.

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SYMPTOMS OF PERNICIOUS ANEMIA:

This kind of anemia is insidious, occurs with progressively increasing symptoms of anemia.

Could be glossitis – angular stomatitis – jaundice….

Neurological symptoms of pernicious anemia:

Dementia – optic atrophy –

peripheral neuropathy:

progressive weakness

Ataxia – Paraplegia because of sub acute degeneration of demyelintion of the corticospinal tracts and posterior columns.
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Laboratory investigations:

Blood count and film:

Hyper segmented neutrophils.

Leucopenia and thrombocytopenia occur in very severe cases.

Serum B12 vitamin:

Is low. Normal > 160 ng/L.

Red cell folate: reduced.

Serum bilirubin:

Is raised caused of ineffective erythropoiesis in the bone marrow witch lead to excess breakdown of hemoglobin.

Serum auto antibodies:

90% of cases present parietal cell antibodies.

50% of cases present intrinsic factor antibodies.

SCHILLING TEST:

Very important for differentiating pernicious anemia from malabsorption anemia as the cause of B12 deficiency.

BONE MARROW EXAMINATION:

Hyper cellular bone marrow with megaloblastic changes…

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COMPLECATION OF PERNICIOUS ANEMIA:

Gastric carcinoma.

MANAGEMENT:

Intramuscular injection 1mg of hydroxycobalamin twice per week for three weeks.

Then three times per month continued for 
life.
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Internal medicine.
Dr.Zafer Maklad
zafernm@yahoo.com