The Macrocytic Anemias

Betty Ciesla

The Macrocytic Anemias and the Megaloblastic Process

The Red Cell Precursors in Megaloblastic Anemia

Ineffective Erythropoiesis in Megaloblastic Anemia

Vitamin B12 and Folic Acid: Their Role in DNA Synthesis

Nutritional Requirements, Transport, and Metabolism of Vitamin B12 and Folic Acid

Incorporating Vitamin B12 Into the Bone Marrow

Clinical Features of Patients With Megaloblas-tic Anemia

Hematological Features of Megaloblastic Anemias

Pernicious Anemia as a Subset of Megaloblastic Anemias

Vitamin B12 and Folic Acid Deficiency

Laboratory Diagnosis of Megaloblastic Anemias

Treatment and Response of Individuals With Megaloblastic Anemia

Macrocytic Anemias That Are Not Megaloblastic

Objectives

After completing this chapter, the student will be able to:

1. Define megaloblastic anemia as a macrocytic anemia.

2. Compare and contrast the morphological characteristics of megaloblasts and normoblasts in the bone marrow.

3. Differentiate red cell and white cell changes in the peripheral smear that are seen in the mega-loblastic anemias.

4. Describe ineffective hematopoiesis as it relates to the megaloblastic process.

5. Describe the pathway of vitamin B12 and folic acid from ingestion through incorporation into the red cell.

6. Describe the clinical symptoms of a patient with megaloblastic anemia.

7. List the causes of vitamin B12 and folic acid deficiency.

8. Define pernicious anemia and its clinical and laboratory findings.

9. Describe the Schilling test and its use in diagnosing megaloblastic anemia.

10. Describe the treatments for the megaloblastic anemias.

11. Differentiate the anemias that are macrocytic but are not megaloblastic.

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