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What causes megaloblastic anemia?
- Vitamin B12 deficiency
- Folic acid deficiency
- Jaundice-->due to increase bilirubin
Megaloblastic erythrocyte maturation
- 1. Promegaloblast
- 2. Basophilic Megaloblast
- 3. Polychromatic megaloblast
- 4. Diffusely basophilic macrocyte
- 5. macrocyte
- Macrocytic, normochromic, RBC inclusions, decreased reticulocyte count
- 2. Low RBC, Hgb, Hct, haptoglobin
- 3. High MCV, MCH, erythropoietin
- 4. Normal MCHC
Where is B12 absorbed and transported?
- Ileum of the SI
- 2. Actively transported by IF (Intrinsic Factor) and TCII (transcobalamine II)
- 3. It is transport to Liver, Marrow and other places
Where is folic acid absorbed and how is it transported?
- 1. absorbed in the duodenum and jejunum
- 2. actively transported:
- polyglutamate-->monoglutamate-->tetrahydrofolate-->liver, and cells
What are the clinical features of folic acid deficiency
- not as severe as B12 deficiency
Differential Diagnosis of B12 and folic acid deficiency?
- 1. serum B12 levels
- 2. serum and RBC folate levels
- 3. antibodies to intrinsic factor
- 4. schilling's test