A Focused Approach to Anemia

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Other Tests in the Anemic Patient

Just as many physicians automatically treat anemia with iron, many also order iron studies even if the anemia does not appear to be compatible with iron deficiency. In this case, there was no need to measure ferritin, iron, or iron-binding capacity. Not only did the patient's disorder bear no resemblance to iron deficiency, iron and ferritin levels are usually misleadingly high in untreated megaloblastic anemia. Even if the patient had an underlying iron deficiency, it would not have been identified, because blood was drawn before the B12 deficiency was corrected.

LDH is useful as an initial screening test. Identification of macrocytic pancytopenia, a high bilirubin level, and an extremely elevated lactate dehydrogenase level can be regarded as megaloblastic anemia until proved otherwise. The low reticulocyte count in this case provided evidence that few new blood cells were emerging from the bone marrow. The test was not essential here; its principal utility is in patients with suspected hemolytic anemia.

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There is pancytopenia and the indices of RBC are macrocytic so in this setting the first Q is megaloplastic or non megaloplastic? and the answer is easy by see hypersegmented neutrophil in peripheral blood film or bone marrow second Q is if megaloplastic what is the cause folate or B12 deficiency and what is the cause of that? if non megaloplastic we have to rule out autoimmune hemolytic anemia, mylodysplastic syndromes, hypothyroidism.


She has gradual onset of anemic symptoms Her CBC shows macrocytic [MCV.95fl],increased RDW .Platelets counts m/b reduced(<100,000/mm3).No h/o recent bleeding exclude IDA.Jaundice exclude haemolytic .Medication with methotrexate, exclude folic acid B12 deficiency.Alcoholism exclude folic acid def.Hospitalization exclude b12 def in gastric operation.Normal BUN exclude anemia of chronic disease. Dx is probably megaloblastic anemia due to combined f/a and B12 deficiency with underlying hypovitaminosis,antimetabolytes, copper deficiency with zinc excess.Bone marrow will show megaloblasts and hypersegmented neutrophils.


Diagnosis is must before blood transfusion in this case


megaloblastic anemia


mostly pernious anaemia

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