Macrocytic Anemia
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| Definition of Macrocytosis | show 🗑
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| What is the bioche mical significance of megablastic anemia? | show 🗑
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| show | (1) Oval macrocytes (2) Hypersegmented PMN (3) Pancytopenia (4) "Giant" bands
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| Describe the mechanism of megaloblasic anemia due to folate deficiency. | show 🗑
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| show | Vitamin B12 is indirectly required for the conversion of folate to a form required for the synthesis of thymidylate.
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| show | In the stomach, vit B12 dissociated from food and binds to R protein. In the duodenum, B12 is released from R protein and binds to intrinsic factor (IF). The B12-IF complex binds to membrane receptors in the ileum.
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| show | Gastric parietal cells
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| show | Vitamin B12 is transported in the plasma by binding to transcobalamin II (TCII)
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| Where is trancobalamin II produced? | show 🗑
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| show | (1) Conversion of homocysteine to methionine (2) Conversion of methylmalonyl-CoA to succinyl-CoA
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| What is the dietary source of cobalamin? | show 🗑
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| show | Intrinsic factor deficiency
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| What conditions cause intrinsic factor deficiency? | show 🗑
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| (T or F) A poor diet is a very common cause of Vitamin B12 deficiency anemia. | show 🗑
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| What portion of the small bowel would result in Vitamin B12 deficiency? | show 🗑
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| show | Pernicious Anemia
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| show | Methylmalonic acid and homocysteine are elevated.
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| What chemical blocks hepatic release of folate into bile? | show 🗑
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| show | Polyglutamate form
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| show | It is a hypothesis that explains how B12 deficiency causes folate deficiency. Cobalamin is needed to convert N5-metyl-FH4 to FH4 (tetrahydrofolate). Colbalamin is a one carbon unit acceptor. In colabalmin deficiency, folate is trapped as N5-methyl-FH4.
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| show | Explains how B12 deficiency results in folate deficiency, based on the concept that only formylated folate can be conjugated. Lack of methionine decreases formate levels, resulting in impaired formylation of FH4, thus no conjugation to N5,10-methylene FH4
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| What are the dietary sources of folate? | show 🗑
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| show | Poor diet (ex: alcoholism, infancy, dialysis)
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| What portion of the small bowel is folate absorbed? | show 🗑
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| show | 1 microgram
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| show | 100 micrograms
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| show | The body stores a small amount that lasts for a few months.
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| How long does the body's storage of cobalamins last? | show 🗑
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| show | Irreversible neruological damage characterized as progressive neuropathy affecting both sensory and motor functions.
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| show | No. Folate administration only correct hematologic abnormalites of Vitamin B12 deficiency, but not the neurological deficits.
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| What conditions can result in both folate and cobalamin deficiency? | show 🗑
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| What is the most likely cause of megaloblastic anemia if the Schillings test results for abnormally low, but normal after intrsinic factor administration? | show 🗑
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