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Megaloblastic Anemias

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Serum or plasma folate (intake & absorption) 2-10 ng/ml. Red cell ... BM transplantation. Immunosuppressive drugs. Growth factors. 41. Related Aplastic Anemias ... – PowerPoint PPT presentation

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Title: Megaloblastic Anemias


1
Megaloblastic AnemiasAplastic Anemias
  • Yuttana Mundee
  • Clinical Microscopy
  • Associated Medical Sciences
  • Chiang Mai University
  • myuttana_at_hotmail.com

2
Hemopoiesis
3
Erythropoiesis
Megaloblastic
Microblastic
Nomoblastic
4
Macrocytic Anemias
  • Anemia with macrocytosis
  • Hb, RBC
  • MCV, MCH
  • MCHC

5
Macrocytic Anemias
  • Megaloblastic macrocytic anemias
  • Megaloblastic anemia
  • Non-megaloblastic macrocytic anemias
  • Others

6
Megaloblastic Anemias
  • Etiology
  • Delay nuclear maturation
  • Normal cytoplasmic maturation
  • Cobalamin (Vitamin B12) deficiency
  • Folic acid deficiency
  • Others

7
Megaloblastic Anemias
  • Clinical Findings
  • weakness
  • lethargy
  • weight loss
  • loss of appetite

- yellow (jaundice) - pallor - red or pale
tongue - loss of sensation - psychosis
8
Megaloblastic Anemias
  • Laboratory Findings
  • Blood
  • Oval macrocytes
  • Howell-Jolly bodies
  • Hypersegmented neutrophils

Bone Marrow - Hypercellularity - ME ratio
- Megaloblastic changes -
Nuclear-cytoplasmic asyncrony
9
Triad of Megaloblastic Anemias 1. Oval
megalocytes 2. Howell-Jolly bodies 3.
Hypersegmented neutrophils
10
B l o o d
Bone Marrow
11
Cobalamin Deficiency
  • Cobalamin
  • DNA synthesis
  • Animal products
  • R protein
  • Intrinsic factor (IF)
  • Transcobalamin (TC)

12
Cobalamin Molecule
13
Cobalamin Absorption
14
Cobalamin Metabolism
15
Cobalamin Deficiency
  • Pernicious anemia (PA)
  • IF deficiency
  • Autoimmune disease
  • Malabsorption
  • Malnutrition
  • TC deficiency

16
Causes of Cobalamin Deficiency
17
Cobalamin Deficiency
  • Laboratory Tests
  • Gastric analysis
  • Schilling test
  • Cobalamin assay
  • Microbiological assay
  • Radiobinding assay
  • MMA assay

18
Schilling Test
19
Schilling Test Interpretation
20
Cobalamin Deficiency
  • Normal range
  • newborns 160-1000 pg/ml
  • children adults 200-1000 pg.ml
  • senile adults 100-800 pg/ml
  • Treatment
  • Vitamin B12 supplement
  • Oral, IM, subcutaneous

21
Folate Deficiency
  • DNA synthesis (TMP synthesis)
  • Vegetables, grains, fruits, dairy products
  • Water soluble
  • Heat labile
  • Poly-glutamic acid
  • Mono-glutamic acid

22
Folic Acid Molecule
23
Folate Absorption
Folate Metabolism
24
Folate Deficiency
  • Causes
  • Inadequate intake
  • Increase demand
  • Malabsorption
  • Inhibitors

25
Causes of Folate Deficiency
26
Folate Deficiency
  • Laboratory Tests
  • Microbiological assay
  • Radioimmuno assay
  • ELISA
  • Chemiluminescence

27
Folate Deficiency
  • Serum or plasma folate (intake absorption)
  • 2-10 ng/ml
  • Red cell folate (availability storage)
  • 150-950 ng/ml

28
Folate Deficiency
  • Treatment
  • Folate supplement
  • Oral route

29
Megaloblastic Anemia Flow Chart
30
Other Megaloblastic Anemias
  • Orotic acidurea
  • Congenital dyserythropoietic anemia

31
Macrocytic Anemias without Megaloblastosis
  • Alcoholism
  • Liver diseases
  • Accelerated erythropoiesis

32
Causes of Macrocytosis without Megaloblastosis
33
Aplastic Anemias
  • Pancytopenia
  • Hypocellularity

34
Aplastic Anemias
  • Bone marrow infiltration
  • Bone marrow suppression
  • Bone marrow failure

35
Normal BM
AA BM
36
Classification of Aplastic Anemias
37
Aplastic Anemias
  • Causes
  • Primary
  • Secondary
  • Chemicals
  • Drugs
  • Radiation
  • Infection

38
Aplastic Anemias
  • Congenital AA
  • Fanconis anemia
  • Dyskeratosis congenita

39
Aplastic Anemias
  • Laboratory Findings
  • Blood
  • pancytopenia
  • Bone marrow
  • hypocellularity

40
Aplastic Anemias
  • Treatment
  • Supportive blood transfusion
  • BM transplantation
  • Immunosuppressive drugs
  • Growth factors

41
Related Aplastic Anemias
  • Pure red cell aplasia
  • Congenital dyserythropoietic anemia

42
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