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Medicine

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Hematology

Question
10 out of 16
 

True about blood finding in pernicious anemia? (LQ)



A MCH High & MCHC high

B MCH high & MCHC normal

C MCH low & MCHC high

D MCH low & MCHC normal

Ans. B

MCH high & MCHC normal

Investigations

Blood film shows hypersegmented (> 5 lobes ) polymorphs are present in B12 deficiency and folate deficiency

Absolute values in megaloblastic anemia

1. Red cell count ---------- Low

2. Hb ---------- Low

3. PCV ---------- Low

4. MCV ---------- High, e.g. (average cell is larger than normal)

5. MCH ----------- High (average cell contains more Hb than normal)

6. MCHC ---------- Normal (Average cell contains normal Hb concentration)

Note: Pancytopenia can occur in pernicious anemia.

Bone marrow biopsy

1. Megaloblastic – B12 or folate deficiency

2. Normoblastic – liver damage, myxoedema

3. Increased erythropoiesis – bleeding or hemolysis

4. Abnormal erythropoiesis – sideroblastic anemia, leukemia, aplastic Anaemia.

Schilling test. It helps to identify the cause of B12 deficiency.

1000 μg im unlabeled vit B12 (to replenish the store) +

1 μg of radiolabeled Vit B12 (oral)

Measure urine Vit B12 level (normally 10% or more excreted)

Abnormal

Give antibiotic for 7 days------à normal Diagnosis – Bacterial overgrowth syndrome

Abnormal

Give Intrinsic Factor (IF)-------à Normal ------------ Pernicious anaemia

Abnormal

Lesion of small intestine leads to malabsorption.

Extra Edge: Causes of hypersegmented neutrophils

1. CRF 2. Vit B12 / Folate Def 3. Myeloproliferative disorder

Hematology Flashcard List

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