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Macrocytic Anemia

Macrocytic Anemia. Clinical pathology department SCU. Normal blood cells . Complete Blood Count (CBC). Normal red blood cells. Definition. An ( without ) - emia ( blood ): a reduction below normal in hemoglobin or red blood cell number. Symptoms and signs of Anemia.

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Macrocytic Anemia

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  1. Macrocytic Anemia Clinical pathology department SCU

  2. Normal blood cells

  3. Complete Blood Count (CBC) Normal red blood cells

  4. Definition An (without) -emia (blood): a reduction below normal in hemoglobin or red blood cell number

  5. Symptoms and signs of Anemia • None if mild • Fatigue • Breathlessness • Dizzines • Pale Skin & mucous membranes • Jaundice ( if hemolytic) • Tachycardia

  6. Differential Diagnosis Using MCV • Macrocytic anemias (MCV = 150 fl): > normal cells • Normocytic (MCV = 80-96 fl): cells are normal in volume • Microcytic anemias (MCV = 50 fl): cells are < normal

  7. Macrocytic anemia • Defined as MCV > 100 femtoliters • Identified by peripheral blood smear or automated RBC indices • Smear is more sensitive in detecting early macrocytic changes and small numbers of macrocytes • Cell morphology can aid in determining etiology of macrocytosis

  8. Common Causes of Macrocytosis

  9. Megaloblastic Anemia • Defective DNA synthesis leads to nuclear/cytoplasmic asynchrony • B12/folate deficiency • Macrocytic anemia with hypersegmented neutrophils

  10. Megaloblastic Anemia • retardedDNA synthesis • unimpaired RNA synthesis • BIG cells! • immature nucleus • maturecytoplasm

  11. How is B12 involved? • B12 (and folate) are required for DNA synthesis. • Slowed DNA synthesis means big, immature nucleus • Cytoplasm (with RNA in it) matures just fine • B12 is also required for conversion of homocysteine to methionine • ↑ homocysteine = atherosclerosis! • ↓ methionine = subacute combined degeneration

  12. Megaloblastic anemia

  13. Megaloblastic anemia

  14. Reticulocyte Count (In the Diagnosis of Anemia) • Useful in determining response and potential of bone marrow. • Reticulocytes are non-nucleated RBCs that still contain RNA. • Visualized by staining with supravital dyes, including new methylene blue or brilliant cresyl blue; RNA is precipitated as dye-protein complex. • Normal range is 0.5-2.0% of all erythrocytes. • If bone marrow responding to anemia, should see increases in retic count. • Newborns have higher retic count than adults until second or third week of life.

  15. Retics Slide

  16. Thank You

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