We present a case with refractory megaloblastic anemia with asymptomatic falciparum malaria. [unboundmedicine.com]

Born 27 May 1975 (1975 05 27) (age 36) Kolar, Karnataka, India Education Bangalore Medical College Karnataka Years active 1999 present … Wikipedia Paroxysmal nocturnal hemoglobinuria — Classification and external resources ICD 10 D59.5 ICD 9 283.2 … Wikipedia [translate.academic.ru]

Giant metamyelocytes are also present. [atlases.muni.cz]

• Hemophilia A

  A, congenital factor VIII disorder 286.1 Hemophilia B, congenital factor IX disorder 289.89 Hypercoagulable state, unspecified 289.89 Hypergammaglobulinemia 280.9 Iron deficiency anemia, unspecified 288.60 Leukocytosis/leucocytosis V58.61 Long-term [hemonc.org]

• Refractory Anemia

  The peripheral blood smear of refractory anemia with ringed sideroblasts is characterized by a dimorphic red cell population. [5minuteconsult.com]

  B12 or folate deficiency - 21% Drug intake - 11% Accelerated erythropoiesis - 7% Liver disease - 6% Refractory anemias - 5% Hypothyroidism - 2% Unexplained - 12% Data from several sources quoted by Colon-Othero et al. [enotes.tripod.com]

  Acquired sideroblastic anemia is often the earliest evidence of a myelodysplastic syndrome (MDS) - refractory anemia with ringed sideroblasts. [med-ed.virginia.edu]

  […] entity exhibiting features of both RARS and Essential Thrombocythemia Note In at least some patients this represents acquisition of a prothrombocythemic JAK2 mutation in a background of RARS Diagnostic Criteria Must satisfy diagnostic features of RARS Refractory [surgpathcriteria.stanford.edu]

  anemia, more likely to progress to AML• Some consider it an intermediate disorder between refractory anemia and refractory anemia with excess blasts• Poor prognosis if even 1% blasts in peripheral blood• Proposed modified criteria are refractory anemia [slideshare.net]

• Asymptomatic

  We present a case with refractory megaloblastic anemia with asymptomatic falciparum malaria. [unboundmedicine.com]

  Clinical features• Asymptomatic - Many patients are diagnosed on routine laboratory screening• Fatigue, weakness, angina - as a result of anemia.• Infections most commonly bacterial, predominate with skin being the most common site. [slideshare.net]

• Collapse

  On the third day of therapy, he had a sudden deterioration of clinical state and developed cardiovascular collapse. In spite of upgrading antibioticsand aggressive management, the child could not be revived. [tropej.oxfordjournals.org]

• Sore Throat

  He had no history of fever, joint pains, recurrent diarrhea or sore throat. He had not received any blood transfusions previously. There was no history of similar complaints in the family. His dietary intake was adequate. [tropej.oxfordjournals.org]

• Pharyngitis

  […] unspecified 787.91 Diarrhea 008.45 Diarrhea, C. diff (Clostridium difficile) 719.7 Difficulty in walking 453.9 I82.91 Deep vein thrombosis (DVT), unspecified site 536.8 Dyspepsia 787.20 Dysphagia, unspecified 787.21 Dysphagia, oral phase 787.22 Dysphagia, pharyngeal [hemonc.org]

• Recurrent Diarrhea

  He had no history of fever, joint pains, recurrent diarrhea or sore throat. He had not received any blood transfusions previously. There was no history of similar complaints in the family. His dietary intake was adequate. [tropej.oxfordjournals.org]

• Petechiae

  Thrombocytopenia typically manifests as petechiae or ecchymoses; epistaxis and gum bleeding suggest severe thrombocytopenia. Hemoptysis, hematuria, and blood in stools may occur. [emedicine.medscape.com]

  […] abdominal-RUQ 338.11 Pain, acute due to trauma 338.18 Pain, acute post-operative 724.5 Pain, back general 724.2 Pain, back lumbar 338.21 Pain, chronic due to trauma 338.28 Pain, chronic NOS 338.3 Pain, neoplasm related 785.1 Palpitations 567.9 Peritonitis 782.7 Petechiae [hemonc.org]

• Fear

  She provides a window into these women's lives, brilliantly portraying their hopes and fears and their struggle to live with dignity. [books.google.de]

Clinical symptoms that should prompt a workup for MDS are due to low peripheral blood counts, usually from the anemia but also from the thrombocytopenia or neutropenia. Symptoms such as fatigue and malaise result from anemia. [emedicine.medscape.com]

Investigative workup revealed normochromic macrocytic anemia with mild anisocytosis (Hb 4.8 g/dl) [Table 1]. Liver function, kidney function, urinalysis, chest roetgenography, and electrocardiography were normal. [ijem.in]

• Macrocytic Anemia

  Examples include causesof splenomegaly, indications for splenectomy, differential diagnosis of normocytic anemia,macrocytic anemia, hypochromic anemia, thrombocytopenia, bone marrow failure syndromes, and manyothers. [books.google.de]

  […] blood or of typical megaloblasts in the marrow ) The nonmegaloblastic anemias (they simply represent macrocytic anemias in which DNA synthesis is unimpaired. [enotes.tripod.com]

  Clinical signs macrocytic normochromic anemia pernicious anemia: also atrophic glossitis, atrophic gastritis, neurologic disorders Histology Peripheral blood: normochromic macrocytic anemia, often pancytopenia, significant anisocytosis, poikilocytosis [atlases.muni.cz]

  Algorithm for the evaluation of macrocytic anemia. (RBC red blood cell; MMA methylmalonic acid.) Evaluation of Macrocytic Anemia Figure 3. Algorithm for the evaluation of macrocytic anemia. (RBC red blood cell; MMA methylmalonic acid.) [aafp.org]

  SUMMARY Deficiency of either folate or cobalamin (vitamin B 12 ) leads to macrocytic anemia with or without other cytopenias as a result of megaloblastic hematopoiesis, a manifestation of defective DNA synthesis. [accessmedicine.mhmedical.com]

• Macrocytosis

  However, this concept remains useful for identifying the most predominant etiology for macrocytosis. [aafp.org]

  B 12 deficiency - macrocytosis, hypersegmented neutrophils, low plasma vit. B12 level. [enotes.tripod.com]

  Megaloblastic anemia and other causes of macrocytosis. Clin Med Res. 2006;4(3):236–241. [View Abstract on OvidInsights] Kaferle J, Strzoda CE. [5minuteconsult.com]

  • Particularly apparent in cases of hypoplastic MDS that share a number of features in common with aplastic anaemia, notably clinical presentation with macrocytosis and varying levels of dyserythropoiesis• Acquired mutations in the PIG-A gene characteristic [slideshare.net]

  […] methylene tetrahydrofolate reductase & in mothers who have autoantibodies to folate receptors) - (Prophylaxis during pregnancy also prevents ALL in children) Neurological manifestations due to cobalamine deficiency (Sometimes occurs without anemia or macrocytosis [sites.google.com]

• Anisopoikilocytosis

  Peripheral smear revealed anisopoikilocytosis, macro-ovalocytes with decreased TLC and reduced platelets. The liver and kidney function tests were normal. The blood and urine cultures were repeatedly sterile. [tropej.oxfordjournals.org]

  • PB smear shows abnormality in all three lines• Red cell anisopoikilocytosis• Large, giant or hypogranular platelets• Abnormal cytoplasmic granularity & nuclear segmentation of neutrophils. [slideshare.net]

• Plasmodium Falciparum

  Introduction Anemia is a well-known complication of Plasmodium falciparum malaria [ 1 ]. Various pathophysiological mechanisms underlie the onset of anemia in this infection. [tropej.oxfordjournals.org]

  falciparum Platelet Transfusion Vitamin B 12 Vitamin B Complex Pub Type(s) Case Reports Journal Article Language eng PubMed ID 20889623 TY - JOUR T1 - Refractory pancytopenia and megaloblastic anemia due to falciparum malaria. [unboundmedicine.com]

• Lymphocytic Infiltrate

  PAS stain … Wikipedia Coeliac disease — Classification and external resources Biopsy of small bowel showing coeliac disease manifested by blunting of villi, crypt hyperplasia, and lymphocyte infiltration of crypts ICD 10 … Wikipedia [translate.academic.ru]

The etiology, clinical features and treatment of 25 cases of idiopathic refractory megaloblastic anemia are described. Attention is directed to the excellent therapeutic effects produced by proteolysed liver or folic acid. 3. [bloodjournal.org]

Long-term outcome of treatment of anemia in MDS with erythropoietin and G-CSF. Blood. 2005 Aug 1. 106(3):803-11. [Medline]. [Full Text]. Clark RE, Jacobs A, Lush CJ, Smith SA. [emedicine.staging.medscape.com]

50% mortality at 18 months Increased risk of thrombotic and hemorrhagic complications Has been linked to Budd-Chiari Syndrome With treatment patients can live for years to decades Usual cause of death in treated patients is progressive marrow fibrosis [brainscape.com]

Treatment should be focused on the underlying cause of hemolysis or hemorrhage. [aafp.org]

• Unravel disease biology• Design accurate diagnostic tests• Predict prognosis• Develop novel therapies 12. [slideshare.net]

PMID 2319806 International scoring system for evaluating prognosis in myelodysplastic syndromes. [atlasgeneticsoncology.org]

[…] carbohydrate solutions (D5 or D10) Hemin infusion—similar molecule to heme which decreases porphyrin production (negative feedback effect) and terminates an attack Beta blockers—for tachycardia and hypertension Analgesics Acute intermittent porphyria prognosis [brainscape.com]

International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997 Mar 15. 89(6):2079-88. [Medline]. [Full Text]. Greenberg PL, Tuechler H, Schanz J, Sanz G, Garcia-Manero G, et al. [emedicine.staging.medscape.com]

The etiology, clinical features and treatment of 25 cases of idiopathic refractory megaloblastic anemia are described. Attention is directed to the excellent therapeutic effects produced by proteolysed liver or folic acid. 3. [bloodjournal.org]

NY, 1998, pg 653 classification (etiology) of megaloblastic anemia Retrieved from " " [anvita.info]

The most common etiologies are alcoholism, vitamin B 12 and folate deficiencies, and medications. [aafp.org]

Pyrimidine antagonists (5-FU, cytosine arabinoside …etc) Others (procarbazine, hydroxyurea, acyclovir, zidovudine) 2- Metabolic disorders Hereditary Orotic aciduria Lesch-Nyhan syndrome 3- Megaloblastic anemia of unknown etiology Refractory Megaloblastic [nanopdf.com]

[…] in whom chronic steroid use is required "Georgia's warm" Cold- immune mediated hemolytic anemia cold reacting antibodies (occurs below body temperature and is mediated by IgM) Complement may directly lyse RBCs or opsonize RBCs for lysis in the spleen Etiology [brainscape.com]

Epidemiology There are few data on the epidemiology of RA, which may account for 30-40% of all MDS cases. MDS is predominantly diagnosed in the elderly population. [atlasgeneticsoncology.org]

Epidemiology of myelodysplastic syndromes and chronic myeloproliferative disorders in the United States, 2001-2004, using data from the NAACCR and SEER programs. Blood. 2008 Jul 1. 112(1):45-52. [Medline]. [Full Text]. Ma X. [emedicine.staging.medscape.com]

Epidemiology of anemia in older adults. Semin Hematol 2008;45:210-7. [Medline] Tettamanti M, Lucca U, Gandini F, et al. Prevalence, incidence and types of mild anemia in the elderly :The «Health and Anemia» population-based study. [revmed.ch]

Tateda, K. (2018) Molecular epidemiology of Klebsiella pneumoniae K1 and K2 isolates in Japan. Diagn Microbiol Infect Dis., 91, 354-359. [med.akita-u.ac.jp]

Various pathophysiological mechanisms underlie the onset of anemia in this infection. [tropej.oxfordjournals.org]

Pathophysiology Etio-pathophysiologic classification of vitamin B12 deficiency Nutritional vitamin B12 deficiency (insufficient intake of vitamin B12-rich animal source foods) Vegetarians, near-vegetarians, breast-fed infants of mothers with pernicious [cancertherapyadvisor.com]

[…] protein deficiency) Lead poisoning Leukemia Liver disease/Liver disorders Malabsorption of folic acid Malnutrition / Starvation Megaloblastic anemia Megaloblastic anemia of pregnancy Methotrexate ( Rheumatrex ) Administration/Toxicity Myeloid metaplasia pathophysiology [wikidoc.org]

Alcohol 26 65 15 36 B 12 and/or folate deficiency 6 9 28 21 Medications 37* 3 2 11 Hypothyroidism — 1 12 5 Bone marrow dysplasias 6 1 5 5 Liver disease (nonalcoholic) 6 — 2 6 Reticulocytosis 8 — — 7 Miscellaneous 3 21 13 7 Not established 7 — 22 12 Pathophysiology [aafp.org]

Deficiency of these will prevent pyrimidine synthesis eading to Megaloblastic anemia. Refer Kaplna biochem 277 for more info Report Abuse This message locked by good2day. No more replies are allowed. [usmleforum.com]

To the contrary, high levels of the T helper type 2 produced cytokine interleukin-10 (IL-10) might prevent the development of severe malarial anemia. Low levels of IL-10 have been described in African children with severe malarial anemia [ 13 ]. [tropej.oxfordjournals.org]

If glutamylation is prevented, the folates cannot be retained in the cell, resulting in an intracellular folate deficiency. [accessmedicine.mhmedical.com]

Anticonvulsants can prevent folate absorption from the small intestine. [cancertherapyadvisor.com]

Although adequate iron is present, a mitochondrial defect (decreased activity of D-ALA or ferrochelatase) prevents the incorporation of iron into hemoglobin. [med-ed.virginia.edu]