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Macrocytic anemia (Vitamin B12 deficiency (Causes (Small bowel disease…

- - - - Pernicious anemia
        
        Autoimmune gastritis
        
        Anti-intrinsic factor antibody
        
        Anti-parietal cell antibody
        
        A/w gastric CA, other autoimmune probs
      - Gastrectomy
      - Gastritis
    - - Celiac disease
      - Blind loops
      - Diphyllobothrium latum infestation
      - Malabsorption syndrome
      - Ileal resection/bypass
- - - - Pregnancy and lactation
      - Hematological disease - hemolytic anemia, myelofibrosis, malignancy, inflammatory diseases
    - - CHF
      - Liver disease
- - - - Oval macrocytes
      - Poikilocytosis - tear drop cells
      - Howell-Jolly bodies - nuclear fragments, dark spots
      - Basophilic stippling
      - Hypersegmented neutrophils
      - Late megaloblasts, nucleated RBCs
    - - Hypercellularity
      - Megaloblastic erythropoiesis - nuclear maturation defect
      - Giant myelocytes, giant band cells
    - - High bilirubin - mild jaundice from high red cell turnover
      - Low transcobalamin (active B12)
      - Low serum folate however can be falsely normal