LabDx

10/25/99

Macrocytic Anemia

• Pernicious anemia—insidious
• Has many entities in it
• B12 or folic deficiency
• Sneaks up on people
• Combined systems disease
• Lose function of posterior columns
• Nutritional
• Nervous system disruption
• Have to have for a long time before systems are bad
• Production of intrinsic factors (carrier molecule of B12)
• Form of demyelination
• Why is B12 so important?
• Part of building block of DNA and RNA
• B12 is in GI tract
• Antibodies against
• Autoimmune disorder
• Tend to have other autoimmune disorders like:
• Type 1 diabetes
• Hypoparathyroidism
• Addison's ds
• Hypopituitism
• Symptoms
• Fatigue
• A feeling of lack of energy, weariness or tiredness
• Not the same as drowsiness
• Apathy (indifference)
• Normal response to physical exertion, emotional stress, lack of sleep
• Nonspecific symptom of psychological or physiological disorder
• Not relieved by adequate rest or adequate sleep or removal of stressful factors
• Clinical evaluation if does not go away by normal means
• Paresthesia
• Lack of sensation, loss of sensation; tingling; sensory loss
• Abnormal sensations, often described as numbness, prickling, or tingling, usually felt along the extremities
• Tingling is an indication of damage or irritation to the nerves in that area
• Unlike numbness, tingling suggests the nerve is not completely dead or severed, just injured or experiencing pressure
• SOB
• Pallor
• Rapid heart beat
• Loss of appetite
• Diarrhea
• Tingling and numbness
• Unsteady gait (ataxia)
• Vestibular
• CNS
• Spinal cord abnormalities
• PNS ds
• Degenerative muscle ds
• Skeletal abnormalities and ds
• Arthritis
• Skin conditions
• Toxic reactions
• Glossitis
• Sore tongue
• Inflammatory condition of the tongue which results in reddening, loss of papilla (giving the tongue a smooth glossy appearance), and irritation
• May be associated w/underlying ds
• Babinski's reflex
• Extensor plantar reflex
• Reflex where the great toe flexes toward the top of the foot and the other toes fan out when the sole of the foot is firmly stroked; normal in children but abnormal after about 2 y/o
• Reflexes are specific, predictable, involuntary responses to a particular type of stimulation
• Signs' and Tests
• CBC—low hematocrit and hemoglobin w/elevated MCV
• Macrocytic, hypochromic
• CBC showing low WBC count (leukopenia) and low platelets (thrombopnea)
• Theses are normal in microcytic anemia
• Low reticulocyte count
• Bone marrow examination
• Serum LDH
• Below normal serum Vit B12 level
• Schilling test—isotope injected to bind B12
• Rapid excretion (measure urine levels)
• Ingest radioactive B12
• Urine measurements
• Amount of B12 is a measure of the absorption
• 2^nd stage provides intrinsic factor
• bacterial overgrowth leads to absorption problem
• Iron deficiency
• Knee pain w/hx or fall
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