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CLINICAL PATHOLOGY DEPARTMENT SCU Macrocytic Anemia.

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Presentation on theme: "CLINICAL PATHOLOGY DEPARTMENT SCU Macrocytic Anemia."— Presentation transcript:

1 CLINICAL PATHOLOGY DEPARTMENT SCU Macrocytic Anemia

2 Normal blood cells

3 Complete Blood Count (CBC) Normal red blood cells

4 Definition An (without) -emia (blood): a reduction below normal in hemoglobin or red blood cell number

5 Symptoms and signs of Anemia None if mild Fatigue Breathlessness Dizzines Pale Skin & mucous membranes Jaundice ( if hemolytic) Tachycardia

6 Differential Diagnosis Using MCV Macrocytic anemias (MCV = 150 fl): > normal cells Normocytic (MCV = fl): cells are normal in volume Microcytic anemias (MCV = 50 fl): cells are < normal

7 Macrocytic anemia Defined as MCV > 100 femtoliters Identified by peripheral blood smear or automated RBC indices  Smear is more sensitive in detecting early macrocytic changes and small numbers of macrocytes  Cell morphology can aid in determining etiology of macrocytosis

8 Common Causes of Macrocytosis cause% of cases Alcohol abuse36% B12 or Folate deficiency21% Chemotherapy or drugs11% Hemolysis or bleeding7% Liver disease6% Primary bone marrow disorders5% Hypothyroidism5% Others12%

9 Megaloblastic Anemia Defective DNA synthesis leads to nuclear/cytoplasmic asynchrony B 12 /folate deficiency Macrocytic anemia with hypersegmented neutrophils

10 Megaloblastic Anemia retarded DNA synthesis unimpaired RNA synthesis BIG cells! immature nucleus mature cytoplasm

11 How is B 12 involved? B 12 (and folate) are required for DNA synthesis. Slowed DNA synthesis means big, immature nucleus Cytoplasm (with RNA in it) matures just fine B 12 is also required for conversion of homocysteine to methionine ↑ homocysteine = atherosclerosis! ↓ methionine = subacute combined degeneration

12 Megaloblastic anemia

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14 Reticulocyte Count (In the Diagnosis of Anemia) Useful in determining response and potential of bone marrow. Reticulocytes are non-nucleated RBCs that still contain RNA. Visualized by staining with supravital dyes, including new methylene blue or brilliant cresyl blue; RNA is precipitated as dye-protein complex. Normal range is % of all erythrocytes. If bone marrow responding to anemia, should see increases in retic count. Newborns have higher retic count than adults until second or third week of life.

15 Retics Slide

16

17 Thank You


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