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    Macrocytic Anemia (New)

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    Slamet Katib
    The document discusses macrocytic anemia caused by vitamin B12 deficiency. It provides 3 key points: 1. Vitamin B12 deficiency can cause macrocytic anemia, characterized by large red blood cells (macrocytic) and low vitamin B12 levels in the blood. 2. Causes of vitamin B12 deficiency include poor diet, reduced stomach production of intrinsic factor, problems absorbing vitamin B12 in the ileum, and other conditions. 3. Symptoms of vitamin B12 deficiency include macrocytic anemia, abnormal blood cells on smear microscopy, and neurological problems if deficiency is untreated for a long time.

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    Macrocytic Anemia (New)

    Uploaded by

    Slamet Katib
    60 views43 pages
    The document discusses macrocytic anemia caused by vitamin B12 deficiency. It provides 3 key points: 1. Vitamin B12 deficiency can cause macrocytic anemia, characterized by large red blood cells (macrocytic) and low vitamin B12 levels in the blood. 2. Causes of vitamin B12 deficiency include poor diet, reduced stomach production of intrinsic factor, problems absorbing vitamin B12 in the ileum, and other conditions. 3. Symptoms of vitamin B12 deficiency include macrocytic anemia, abnormal blood cells on smear microscopy, and neurological problems if deficiency is untreated for a long time.

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    macrocytic anemia

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    (7) Macrocytic Anemia(New)

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    The document discusses macrocytic anemia caused by vitamin B12 deficiency. It provides 3 key points: 1. Vitamin B12 deficiency can cause macrocytic anemia, characterized by large red blood cells (macrocytic) and low vitamin B12 levels in the blood. 2. Causes of vitamin B12 deficiency include poor diet, reduced stomach production of intrinsic factor, problems absorbing vitamin B12 in the ileum, and other conditions. 3. Symptoms of vitamin B12 deficiency include macrocytic anemia, abnormal blood cells on smear microscopy, and neurological problems if deficiency is untreated for a long time.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    60 views43 pages

    Macrocytic Anemia (New)

    Uploaded by

    Slamet Katib
    The document discusses macrocytic anemia caused by vitamin B12 deficiency. It provides 3 key points: 1. Vitamin B12 deficiency can cause macrocytic anemia, characterized by large red blood cells (macrocytic) and low vitamin B12 levels in the blood. 2. Causes of vitamin B12 deficiency include poor diet, reduced stomach production of intrinsic factor, problems absorbing vitamin B12 in the ileum, and other conditions. 3. Symptoms of vitamin B12 deficiency include macrocytic anemia, abnormal blood cells on smear microscopy, and neurological problems if deficiency is untreated for a long time.

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    © All Rights Reserved
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    of 43

    MACROCYTIC ANEMIA

    Sahyuddin
    Tutik Harjianti
    A. Fachruddin B
    Div. of Hematology & Medical Oncology
    Dept. of Internal Medicine, Medical Faculty
    Hasanuddin University

    Deficiency Cyanocobalamin

    B12 : all of it made from diet


    A food ingredients may from animal.
    Absorbtion : 5 ug / days
    Cofactor at 2 important reaction in a body

    Division of Hematology & Medical Oncology Dept. of Internal Medicine

    The role of Cyanocobalamin

    Methyl-Cobalamin is a cofactor for methioninesynthetase at rx change of homosystein


    metyonin.
    Adenosyl-Cobalamin is a cofactor at rx change
    of methyl-malonyl CoA succinyl-CoA

    Division of Hematology & Medical Oncology Dept. of Internal Medicine

    Deficiency Cyanocobalamin
    An important sign :
    1. macrocytic Anemia
    3. Level of Vit B12 <100 pg/ ml

    sign

    2. Peripheral blood smear:


    macro-ovalocyte & hypersegmented neutrophil

    Division of Hematology & Medical Oncology Dept. of Internal Medicine

    Macrocytic

    Normocytic
    Division of Hematology & Medical Oncology Dept. of Internal Medicine

    The Cause
    1. Deficiency vit B12 (diet)
    2. The decrease production of intrinsic factor
    (Anemia perniciosa, post-gastrectomy)
    2. The decrease absorbtion of vit B12 at the ileum
    (Post-op, Crohn ds)
    3. Helmynthyasis (tape-worm)
    4. Deficiency Transcobalamin II

    Division of Hematology & Medical Oncology Dept. of Internal Medicine

    Physiology
    Vit B12 come in from IT binding with intrinsic
    factor (made from parietal mucosa gaster cell)
    abs in ileum terminal by spesific receptor
    come in to the plasma liver .
    There are 3 protein transporter in the plasma :
    Trans-cobalamin I, II & III (by leukocyte). Only
    Trans-cobalamin II that can transport vit B12
    into the cell.

    Division of Hematology & Medical Oncology Dept. of Internal Medicine

    Division of Hematology & Medical Oncology Dept. of Internal Medicine

    Phatogenesis
    Hepar consist 2.000 5.000 ug vit B12
    Need : 3 5 ug / hari
    Defs vit B12 will be happen in 3 years after no
    more absorpsi.
    Defs caused by diet less vit B12 vary rare
    ( vegetarian )

    Example :

    Gastrectomy the area produce factor


    intrinsik will decrease
    Over-growth bactery in intestinal
    Reseksi ileum the area of absorpsi vit
    B12 will decrease
    Helmenthyasis
    Crohns disease ileum destruction
    the area of absorpsi vit B12 will decrease

    Anemia Perniciosa
    Often cause defs B12
    Abnormality Auto-Imun herediter
    Seldom show before 35 years old
    Scandinavia / Eropa Utara
    A black skin teenager, a hispanic woman

    Anemia Perniciosa
    Clinic illustration :
    Likely anemia caused byndefs vit B12,
    - Gastritis atrophic
    - Abnormal Auto-Imun ( rheumatoid arthritis
    Graves disease, defs IgA )
    - After several years some patient
    Gastritis Atrophic => Carcinoma Gaster

    CLINIC ILLUSTRATION
    DEFS. VIT B12
    Megaloblastic anemia
    May a hard anemia ( hematokrit < 10 % )
    A change mucosa cell : glossitis, anorexia,
    diare.
    Neurologic disturb:
    1. Perifer parestesi
    2. Cerebral difunct

    Lab. Abnormal
    1. Megaloblastic Anemia
    2. MCV between 110 140 fl (increase)
    at some patient : MCV normal
    ( thalassemia , defs Fe )
    3. Blood Perifer : anisocitosis &
    poikilocitosis. Specif : makro-ovalosit.

    Blood Perifer
    4.Morfologi eritrosit very abnormal
    Likely Hemolytic Anemia
    5. Hypersegmentasi netrofil
    6. Reticulocit amount decrease

    Bone Marrow Asp


    Eritropoesis in-efektif ( ggn produksi RBC )
    hiperplasi eritroid ( as respons )
    Cell megaloblast abnormal in SST diferent shape :
    * big abnormal size,
    * maturasi inti & sitoplasma tdk.sinkron.
    Maturasi cytoplasm is normal,
    DNA synthesis is bother
    Seri mieloid : Giant sel meta-mielosit

    Other Lab. Abnormal :


    In-efektif eritropoesis in SST may happen
    destruction eritroid cell that in the development
    period level LDH ( lactic-dehydrogenase )
    very increase, and Bilirubin indireck increase
    just for a little

    Diagnosis
    1. Level vit B12 serum is less
    ( normal : 150 -350 pg / mL )
    2. Schilling test ( for dx A Perniciosa /
    the decrease absorpsi vit B12 oral )
    1st step : the patient injection w/ Vit B12 i.m

    Then give vit B12 that has di-label p.o


    Retain urine 24 hours
    ( Normal : > 7 % )

    Test Schilling 2nd step


    Give vit B12 that has , with the intrinsic
    factor.
    If the patient Anemia Perniciosa ( defs intrinsic
    factor ), so absorpsi will fixed.
    At a hard case ( epitel usus abnormal )
    malabsorption the result of test Schilling II
    may still abnormal sp defek mukosa usus pulih.

    THERAPY
    *

    At Anemia Pernisiosa ( oral absorpsi


    disfun)
    Intra-muscular Inj. Vit B12 ( IM )
    Dosis : 200 ug
    1st week : every day (replacement tx)
    2nd 4th week : every week
    Once a month

    Respons Therapy
    Usually easy to show, GC better, the complain
    decrease.
    Retyculocitosys happen in 5 7 days.
    Abnormalitas hermatologic will be dissappear
    after 2 months.
    SSP disorder will be dissappear if we give
    therapy before 6 months sick.

    Division of Hematology & Medical Oncology Dept. of Internal Medicine

    Pathogenesis

    Division of Hematology & Medical Oncology Dept. of Internal Medicine

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