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Clinical Features

Clinical Features. Clinical Features. Anemia – easy fatigability, pallor and reduced exercise capacity GI manifestations – glossitis , loss of appetite, nausea , and constipation Neurologic manifestations ( Cobalamin )

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Clinical Features

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  1. Clinical Features

  2. Clinical Features • Anemia – easy fatigability, pallor and reduced exercise capacity • GI manifestations – glossitis, loss of appetite, nausea, and constipation • Neurologic manifestations (Cobalamin) • Paresthesiasin the feet and fingers, poor gait, and memory loss (early stage) • Severe disturbances in gait, loss of position sense, blindness due to optic atrophy, and psychiatric disturbances (late stage)

  3. Clinical Features Patient • Palpitations • Easy fatigability • Shortness of breath • Pallor (oral mucosa, conjunctiva) • Leg pains • No fever • Steady weight • Smooth, red tongue • No PND nor orthopnea • No bladder or bowel complaints • Pins-and-needles sensations in the fingertips • Profuse menstrual bleeding • Strict vegetarian for 5 years Megaloblastic anemia • Anemia • GI manifestations • Neurologic manifestations

  4. Hematologic Findings

  5. Peripheral Blood • Main Feature: oval macrocytes usually with considerable anisocytosis and poikilocytosis • Neutrophilsare hypersegmented (more than five nuclear lobes)

  6. Bone Marrow • Hypercellularwith an accumulation of primitive cells • Cells are larger than normoblasts • Eccentric lobulated nuclei or nuclear fragments may be presen

  7. Chromosomes • Bone marrow cells, transformed lymphocytes and other proliferating cells in the body show a variety of changes including random breaks, reduced contraction, spreading of the centromere and exaggeration of secondary chromosomal constrictions and overprominent satellites.

  8. Ineffective Hemopoeisis • Accumulation of unconjugatedbilirubin due to death of red cell • Raised urine urobilinoge, reduced haptoglobins, positive urine hemosiderin, raised serum lactate dehydrogenase

  9. Patient: Laboratory Findings • CBC: Hgb 75 g/L (120 g/L to 160 g/L) • Hct: 24 % (Hct (Male), 39 - 54%. Hct (Female), 34 - 47%) • MCV: 78.3 U3 (80 U3-100U3) • MCH: 16.20 pg (27 pg-33 pg) • MCHC: 21.5 g/dL (31 g/dL to 35 g/dL) • Platelet: 500 x 10 9/L (150 to 400 x 10 9/liter) • WBC: 12.2 x 10 9/L (4.3 to 10.8 x 10 9/L ) • Segmenters: 0.72 • lymphocytes: 0.28 • Peripheral smear: severe hypochromicRBCs with remarkable anisocytosis, no abnormal WBCs but with some hypersegmentedneutrophils, platelet count is increased.

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