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Macrocytic Anemia (s/s of anemia or CBC finding: Low Hb (MCV check (…

- - - - Macrocytic anemia
        
        Production anemia: Reticulocyte count must be low
        
        Separate btw megaloblastic vs nonmegaloblastic
        
        Smear
        
        :check:Hypersegmented neutrophils (≥5 lobes)
        
        megaloblastic anemia
        
        B12 def
        
        folate def
        
        Check B12, folate
        
        3 more items...
        
        :green_cross:no hyperseg neutrophils
        
        :checkered_flag:Non Megaloblastic anemia
        
        Liver disease (cirrhosis)
        
        Etoh :beer: w/ or w/o cirrhois
        
        Drugs: :pill: CTX (5FC, AraC, Retrovirals, AZT)
        
        metabolic (inherited) : Lesch Nyhan, Hereditary Orotic Aciduria
        
        low yield
        
        :pencil2:Megaloblastic = impaired DNA synth
        
        :pencil2:Macrocytic = big
- - - - If not low, MMA: no elevation in MMA
        
        :warning:Homocysteine levels (elevated in folic acid/ B12 def) is not diagnostic. Forget it now!
- - - - Pernicious anemia
      - Crohn's Disease
      - Gastric Bypass
      - Dx: B12
        Tx: B12
        
        PO or SubQ depends on sit.
        
        MMA if indeterminate
        MMA elevated in B12
        
        SubQ indication
        
        bad Absorption
        
        Stomach
        
        bad in Pernicious anemia
        
        Gastric Bypass
        
        Terminal Ileum
        
        Fistula in Crohns disease
        
        Schiling's Test
        
        Impaired absorption or nutritional deficit
        
        Give SubQ injection of B12, saturates the liver.
        
        Then give PO B12
        
        Check urine
        
        :check: B12 in urine
        
        Pt able to absorb it: Nutritional Deficiency
        
        :green_cross: no B12 in urine
        
        absorption problems
        
        :warning:Don't pick as next :stars:best step. But know how to interpret