Presentation
We present a case with refractory megaloblastic anemia with asymptomatic falciparum malaria. [unboundmedicine.com]
Giant metamyelocytes are also present. [atlases.muni.cz]
[…] including its relationship with Other systems and disorders Internal medicine Immunology Microbiology Histopathology Clinical chemistry Essentially an annotated index, The CRC Desk Reference for Hematology provides an accessible reference, featuring a novel presentation [books.google.de]
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]
Entire Body System
- Refractory Anemia
The peripheral blood smear of refractory anemia with ringed sideroblasts is characterized by a dimorphic red cell population. [5minuteconsult.com]
Nonmegaloblastic anemias were most often associated with alcoholism and liver disease or with hemolytic anemia. Less commonly, they were noted in patients with a variety of refractory anemias. [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]
More aggressive than refractory 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 [slideshare.net]
Respiratoric
- 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]
Workup
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]
Serum
- Macrocytic Anemia
TOC | HEME Approach to Macrocytic /Megaloblastic Anemia By means of morphologic and biochemical criteria, macrocytic anemias can be divided into two groups: The megaloblastic anemias ( the presence of hypersegmented neutrophils and oval macrocytes in [enotes.tripod.com]
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]
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]
Microbiology
- 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]
Male Nitric Oxide Synthase Type II Pancytopenia Plasmodium 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 [unboundmedicine.com]
Treatment
Myelodysplastic Syndromes Treatment (PDQ®)–Health Professional Version. National Cancer Institute. Available at http://www.cancer.gov/cancertopics/pdq/treatment/myelodysplastic/HealthProfessional/page1#Reference1.9. [emedicine.staging.medscape.com]
insufficient acid to maintain iron in Fe2+ state Malabsorption - intestinal resection, altered nRAMP2 gene (DCT1 aka DMT1) - facilitates Fe2+ transport across brush border d/t auto phlebotomy Affected patients have underlying psychiatric problems; treatment [brainscape.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]
Treatment should be focused on the underlying cause of hemolysis or hemorrhage. [aafp.org]
Prognosis
• 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]
Etiology
From Jump to: navigation, search Contents 1 Etiology 2 More General Terms 3 Additional Terms 4 References Etiology vitamin B12 deficiency inadequate intake: vegetarians (rare) malabsorption : inadequate production of intrinsic factor pernicious anemia [anvita.info]
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]
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
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]
Harada, S., Ishii, Y., Saga, T., Aoki, K., 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]
Pathophysiology
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]
Various pathophysiological mechanisms underlie the onset of anemia in this infection. [tropej.oxfordjournals.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]
Prevention
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]
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]
- Prevented by 0.4mg folic acid daily. [sites.google.com]