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anaemia. (macrocytic (True Macrocytisis (Non-megaloblastic (Marrow failure…

- - - - ana abnormally large nucleated red ce;ll precursor with an immature nucleus.
        
        cytoplasm has developed and is larger than normal but there is still an immature nucleus
        
        Nucleus eventually lost but RBC is still large.
        
        cell senses it has enough Hg so doesnt need to divide hence larger.
      - Characterised by defects in DNA synthesis and nuclear matruation with relative preservation of RNA and Hg synthesis.
        
        NOT DUE TO INCREASE IN SIZE OF DEVELOPING CELL BUT A FAILURE TO BECOME SMALLER.
      - Causes
        
        other: drugs
        
        Anticonvulsants= folate defic.
        
        folate defic
        
        dietary folate absorbed in jejunum
        
        rare inherited abnormalitys
        
        B12 defic.
        
        absorbed in terminal bowel with intrinsic factor
        
        lack of IF= pernicious anaemia
    - - liver disease (affects RBC membrane)
      - hypothyroidism
      - Alcohol excess
      - Marrow failure
        
        Myeloma
        
        myelodysplasia
        
        Aplastic anaemia
  - - - high retic count. retics are bigger than normal RBC so throws off the MCV measurment
      - cold-aggulations occurs OUTSIDE the body
        
        clumps of RBC are measured as 1 giant cell
  - - - Raised
        
        haemorrhage
        
        haemolysis
      - normal/ decreased
        
        Do a blood film
        
        Hypersegmented nuetrophils. Macroovalocytes
        
        Yes
        
        Check serum B12 and/or Folate
        
        Low- normal
        
        2 more items...
        
        High-Normal :
        
        1 more item...
        
        No
        
        Other conditions assoc with macrocytosis: licer disease, hypothyroid, alcoholism
        
        If none of these......
        
        1 more item...
- - - - Iron deficiency
        
        Dietary
        
        Veggies
        
        COMMON
        
        Unlikely in men.
        
        malabsorption: coeliac, achlorydria
        
        Blood loss
        
        Menorrhagia
        
        GI losses
      - rarer causes:
        
        problems with porphyrin synthesis -VERY rare
        
        lead poisoning
        
        pyridoxine responsive anaemias
        
        congenital sideroblastic anaemia- VERY rare cant make the porphyrin ring
        
        Congenital= Paeds
        
        Haem gets stuck in the mitochondria
        
        G6DP defic.
        
        protects against free radicals from Fe so reduces RBC life span.
      - Globin deficiency
        
        Thalassemia- globin chain probs
        
        more common in other countries
- - - - cytoplasmic-Hg defic
      - nuclear defecit : impaired cell division.
- - - - chronic disease->lack of available iron (normal body stores)
        
        Tends to be normocytic