Megaloblastic Anemias

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Megaloblastic AnemiasAplastic Anemias

• Yuttana Mundee
• Clinical Microscopy
• Associated Medical Sciences
• Chiang Mai University
• myuttana_at_hotmail.com

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Hemopoiesis
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Erythropoiesis
Megaloblastic
Microblastic
Nomoblastic
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Macrocytic Anemias

• Anemia with macrocytosis
• Hb, RBC
• MCV, MCH
• MCHC

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Macrocytic Anemias

• Megaloblastic macrocytic anemias
• Megaloblastic anemia
• Non-megaloblastic macrocytic anemias
• Others

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Megaloblastic Anemias

• Etiology
• Delay nuclear maturation
• Normal cytoplasmic maturation
• Cobalamin (Vitamin B12) deficiency
• Folic acid deficiency
• Others

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Megaloblastic Anemias

• Clinical Findings
• weakness
• lethargy
• weight loss
• loss of appetite

- yellow (jaundice) - pallor - red or pale
tongue - loss of sensation - psychosis
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Megaloblastic Anemias

• Laboratory Findings
• Blood
• Oval macrocytes
• Howell-Jolly bodies
• Hypersegmented neutrophils

Bone Marrow - Hypercellularity - ME ratio
- Megaloblastic changes -
Nuclear-cytoplasmic asyncrony
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Triad of Megaloblastic Anemias 1. Oval
megalocytes 2. Howell-Jolly bodies 3.
Hypersegmented neutrophils
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B l o o d
Bone Marrow
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Cobalamin Deficiency

• Cobalamin
• DNA synthesis
• Animal products
• R protein
• Intrinsic factor (IF)
• Transcobalamin (TC)

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Cobalamin Molecule
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Cobalamin Absorption
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Cobalamin Metabolism
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Cobalamin Deficiency

• Pernicious anemia (PA)
• IF deficiency
• Autoimmune disease
• Malabsorption
• Malnutrition
• TC deficiency

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Causes of Cobalamin Deficiency
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Cobalamin Deficiency

• Laboratory Tests
• Gastric analysis
• Schilling test
• Cobalamin assay
• Microbiological assay
• Radiobinding assay
• MMA assay

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Schilling Test
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Schilling Test Interpretation
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Cobalamin Deficiency

• Normal range
• newborns 160-1000 pg/ml
• children adults 200-1000 pg.ml
• senile adults 100-800 pg/ml
• Treatment
• Vitamin B12 supplement
• Oral, IM, subcutaneous

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Folate Deficiency

• DNA synthesis (TMP synthesis)
• Vegetables, grains, fruits, dairy products
• Water soluble
• Heat labile
• Poly-glutamic acid
• Mono-glutamic acid

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Folic Acid Molecule
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Folate Absorption
Folate Metabolism
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Folate Deficiency

• Causes
• Inadequate intake
• Increase demand
• Malabsorption
• Inhibitors

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Causes of Folate Deficiency
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Folate Deficiency

• Laboratory Tests
• Microbiological assay
• Radioimmuno assay
• ELISA
• Chemiluminescence

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Folate Deficiency

• Serum or plasma folate (intake absorption)
• 2-10 ng/ml
• Red cell folate (availability storage)
• 150-950 ng/ml

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Folate Deficiency

• Treatment
• Folate supplement
• Oral route

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Megaloblastic Anemia Flow Chart
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Other Megaloblastic Anemias

• Orotic acidurea
• Congenital dyserythropoietic anemia

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Macrocytic Anemias without Megaloblastosis

• Alcoholism
• Liver diseases
• Accelerated erythropoiesis

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Causes of Macrocytosis without Megaloblastosis
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Aplastic Anemias

• Pancytopenia
• Hypocellularity

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Aplastic Anemias

• Bone marrow infiltration
• Bone marrow suppression
• Bone marrow failure

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Normal BM
AA BM
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Classification of Aplastic Anemias
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Aplastic Anemias

• Causes
• Primary
• Secondary
• Chemicals
• Drugs
• Radiation
• Infection

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Aplastic Anemias

• Congenital AA
• Fanconis anemia
• Dyskeratosis congenita

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Aplastic Anemias

• Laboratory Findings
• Blood
• pancytopenia
• Bone marrow
• hypocellularity

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Aplastic Anemias

• Treatment
• Supportive blood transfusion
• BM transplantation
• Immunosuppressive drugs
• Growth factors

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Related Aplastic Anemias

• Pure red cell aplasia
• Congenital dyserythropoietic anemia

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