Causes of microcytic anemia mnemonic tails it stands for. These 3 tests will help classify the anemia in microcytic, normocytic, and macrocytic anemia, evaluate bone marrow response, and evaluate rbc morphology. Elevated mean corpuscular cell volume, or mcv, on a cbc refers to a cell that is macrocytic, or an abnormally large red blood cell. Descriptive analysis of the prevalence of anemia in a randomly selected sample of elderly people living at home. Is the anemia microcytic small red blood cell size. Evaluation includes testing for iron deficiency measuring serum ferritin and hemoglobinopathies using hemoglobin electrophoresis. Anemia knowledge for medical students and physicians. Megaloblastic macrocytic anemias hematology and oncology. A subtype of macrocytic anemia occurs with a normal rdw. The term macrocytic is from greek words meaning large cell. Clinical features, if present, are mostly nonspecific. Objectives generate a differential diagnosis for anemia based on the results of a cbc.
The smear shows macroovalocytosis, anisocytosis, and poikilocytosis. Causes of microcytic anemia mnemonic tails pg blazer. Medical mnemonics macrocytic anemia, hypothyroidism, pregnancy pills. If an intramuscular injection is unavailable, sublingual tablets at mcg q. Anemia is a reduction of the oxygencarrying capacity of the blood, which results in decreased oxygen supply to tissue cells. Physiologically, anemia is a condition in which reduced hematocrit or hemoglobin levels lead to diminished oxygencarrying capacity that does not optimally meet the metabolic demands of the body. Is there decreased rbc production, increased loss rbc destruction or rbc loss i. The prevalence of macrocytic anaemia and its underlying aetiology were analysed in a general practice population. Microcytic, normocytic, and macrocytic anemias video khan. Two ways to think about anemia, destructionblood loss vs underproduction. Make sure to use proper draping dont forget to tie back patients gown. Cbc w diff, reticulocyte count, and peripheral blood smear to help classify the anemia in microcytic mcv macrocytic mcv 100, anemia, evaluate bone marrow response, and evaluate rbc morphology.
Make sure to wash your hands or wear gloves before you start physical examination. Microcytic mcv 100 i love my mnemonic half md which i made up when was i was half of an md in 3rd year of medical school. Microcytic anemia has been discussed by weng et al. A mnemonic commonly used to remember causes of microcytic anaemia is. Normocytic anemia can be further divided into intrinsic and extrinsic rbc defect and blood loss. The workup for macrocytic anemia should include some or all the following. Because the causes of normocytic anemias are better categorized under other sections of this text, we only place the differential diagnosis of normocytic anemia below. A macrocytic class of anemia is an anemia defined as blood with an insufficient concentration of hemoglobin in which the red blood cells erythrocytes are larger than their normal volume. Macrocytic anemia is most often the result of alcoholism, liver disease, vitamin b12 or folate deficiency, or primary marrow dysfunction myelodysplasia or preleukemia. Anemia in pregnancy merck manuals professional edition. Macrocytic anaemia is most commonly due to a deficiency of vitamin b 12 or folate.
These oral lesions typically occur at the time when folate depletion is severe enough to cause megaloblastic anemia, although, occasionally, lesions may occur before the anemia. Red cell folate levels bc it is not affected by the intake of folate rich foods what is secreted in the urine and is an indirect indication of vb12. This collection features afp content on anemia and related issues, including blood transfusions, iron deficiency and iron supplementation, macrocytosis, microcytosis, and thalassemia. Fetus pregnancy alcohol thyroid diseaseie hypothyroidism reticulocytosis b12 and folate deficiency cirrhosis and chronic liver disease. Macrocytic anemia ma can be secondary to malabsorption of nutrients or a side effect of haart. In macrocytic anemia, the mean corpuscular volume mcv is higher. Prevalence of potential underlying aetiology of macrocytic. In metric terms the size is given in equivalent cubic. Anemia such as that seen in chronic kidney disease is both due to decreased erythropoietin decreased production and decreased red blood cell lifespan. Schrier in mentzer 2015 diagnosis and treatment of vitamin b12 and folate.
Microcytic anaemia is any of several types of anaemia characterized by small red blood cells called microcytes. Cbc w diff look at the hgb and hct, mcv, and platelet count. Microcytic anemia definition of microcytic anemia by. Mar 15, 2017 macrocytic anemia can be broken into two main types. Forgetfulness mnemonicbest usmle step 2 cs mnemonics. The three main classes of anaemia include excessive blood loss acutely such as a. After you have interpreted the first three tests, order additional tests from the list below to further workup the anemia. Pancytopenia advanced b12 deficiency target cells chronic liver disease anemia and thrombocytopenia are also seen.
Anemia is a medical condition in which there are not enough healthy red blood cells to carry oxygen to the tissues in the body. Macrocytic anemia, in which the average size of circulating red cells is larger than normal, results from impaired production of red cellse. The tongue may appear swollen, beefy, red, or shiny, usually around the edges and tips initially. Vitamin b12 deficiency, pernicious anemia, b12 deficiency, cobalamin deficiency, cyanocobalamin deficiency. Acute bleeding may briefly produce macrocytic indices because of the release of large young reticulocytes.
The potential effect of the different aetiology on survival was also evaluated. Mar 23, 2020 categorized by mean corpuscular volume, anemia can be differentiated into microcytic, macrocytic and normocytic anemias. Hematology mnemonics macrocytic anaemia macrocytic anaemia leaves big. Pancytopenia advanced b12 deficiency target cells chronic liver disease. Key cd markers for hematology disorders the barone zone. The amount of hemoglobin increases proportionately with the increase in cell size. Acute blood loss bone marrow failure chronic disease destruction hemolysis abcd. When fully developed, the anemia is macrocytic, with mcv 100 flcell in the absence of iron deficiency, thalassemia trait, or renal disease.
Make sure to ask for permission before you start each physical exam. What lab tests should be run if macrocytic anemia is suspected. Macrocytic indices occur with impaired dna synthesis eg, due to vitamin b12 or folate deficiencies or chemotherapeutic drugs such as hydroxyurea and antifolate agents and in alcoholism because of abnormalities of the cell membrane. Megaloblastic anemias are a group of macrocytic anemias in which the bone marrow shows megaloblastic erythropoieses. Hematology mnemonics macrocytic anaemia macrocytic. Macrocytic anemia definition of macrocytic anemia by. Finally, anemia of chronic disease can be normocytic in some patients and should be included in the normoctyic anemia differential diagnosis. His high energy style and mnemonics make learning medicine fun. Folate deficiency is suspected if cbc shows anemia with macrocytic indices or high rbc distribution width rdw. Megaloblastic anemia is suspected in anemic patients with macrocytic indices. Make sure to explain each physical examination in laymans term to your patient. Macrocytic anemias have several causes but with the implementation of folic acid fortification in north america, folic acid deficiency has become a rare cause of megaloblastic macrocytic anemia in that part of the world.
In this type of anemia, the mcv is lower than 80 m. Dec 16, 2018 macrocytosis is a term used to describe erythrocytes that are larger than normal, typically reported as mean cell volume mcv greater than 100 fl. In this region, vitamin b 12 deficiency is a far more common cause of megaloblastic macrocytic anemia. Thalassemia anemia of chronic disease iron deficiency anemia lead poisoning sideroblastic anemia. Here is a mnemonic from category pathology named anemia normocytic. Acute blood loss bone marrow failure chronic disease destruction hemolysis. Anemia is defined as a decrease in the quantity of circulating red blood cells, represented by a reduction in hemoglobin concentration, hematocrit, or rbc count. Anemia is a clinical finding that arises from many etiologies. However, literature on the prevalence of the different causes in this population is limited. Green chapter contents megaloblastic hemopoiesis 197 vitamin b12related and folaterelated causes of megaloblastic anemia 198 vitamin b12 198 folates 206 vitamin b12independent and folateindependent causes of megaloblastic erythropoiesis 208 abnormalities of nucleic acid synthesis 208 uncertain etiology 209 macrocytosis with. Cbc w diff, reticulocyte count, and peripheral blood smear to help classify the anemia in microcytic mcv 100, anemia, evaluate bone marrow response, and evaluate rbc morphology.
Describe a reasonable initial approach to ordering tests and. Macrocytic mcv 100 i love my mnemonic half md which i made up when. Anemia is a reduction of the oxygencarrying capacity of the blood, which results in. Hematology mnemonics macrocytic anaemia macrocytic anaemia. Anemia is strongly correlated with increased rates of death and mobility disability in older communitydwelling whites but not blacks. Vitamin b 12 hydroxocobalamin, methylcobalamin, cyanocobalamin mcgml given im three times a week for proper cell division and differentiation.
Simultaneous measurement of reticulocyte and red blood cell indices in healthy subjects and patients with microcytic and macrocytic anemia. Microcytic, macrocytic and normocytic anemia see online here anemia is one of the major reasons why patients present with shortness of breath, fatigue, pallor, and weakness. Peripheral blood smear hypersegmented neutrophils and macroovalocytes b12 or folate deficiency. Anemia is defined by a hemoglobin hgb value at least two standard deviations below the mean for age and sex normocytic.
Hematology mnemonics macrocytic anaemia macrocytic anaemia leaves big fat reticulocytes myxoedema, alcohol, liver disease, b12 def. Compensatory reticulocytosis blood loss and hemolysis. Macrocytic anemia an overview sciencedirect topics. Dr barone teaches usmle pathology, internal medicine, medical genetics, immunology, and physiology. Classification of anemia diagnostic approach to anemia. The world health organization has defined anemia as a hemoglobin concentration below 7. Macrocytic anemias usually defined as mcv greater than 100 fl. Macrocytic anaemia definition of macrocytic anaemia by. In other circumstancesfor example, when there is a deficiency of ironthe circulating red cells are. Other articles where macrocytic anemia is discussed.
In general, normocytic anemias are caused by failure of the bone marrow to conduct proper hematopoiesis. The workup for macrocytic anemia should include an peripheral blood smear, serum b12 and folate levels, liver chemistry studies, tsh, and. See more ideas about macrocytic anemia, health and nutrition and folic acid. Normal mean corpuscular volume or mcv and low reticulocyte counts. What should you look for if you suspect macrocytic anemias. What is the most reliable test for macrocytic anemia. The workup for macrocytic anemia should include an peripheral blood smear, serum. Cause of microcytic anemia is the bodys limited ability to absorb iron and the frequent loss of iron owing to haemorrhage. Symptoms include fatigue, weakness, pallor, dizziness, and fainting. Simultaneous measurement of reticulocyte and red blood cell indices in healthy subjects and. Anemia workup diagnostic tests for anemia time of care. Further workup is essential in learning the etiology and acuity. Other causes that are typically thought of as causing normocytic anemia or macrocytic anemia must also be considered, and the presence of two or more causes of anemia can distort the.
Normocytic anemias are a categorization of anemias defined as those anemias which display normalsized erythrocytes i. The normal mean corpuscular volume abbreviated to mcv on full blood count results, and also known as mean cell volume is approximately 80100 fl. This topic discusses causes of macrocytosis and macrocytic anemia. Evaluation of anemia merck manuals professional edition. The normal erythrocyte volume in humans is about 80 to 100 femtoliters fl 10. Categorized by mean corpuscular volume, anemia can be differentiated into microcytic, macrocytic and normocytic anemias. Microcytic anemia normocytic anemia with a normal mcv macrocytic anemia with a high mcv. The treatment for vitamin b12deficient macrocytic and pernicious anaemias. Use a three part strategy to narrow the differential diagnosis of anemia. Sep 27, 2019 pediatric anemia refers to a hemoglobin or hematocrit level lower than the ageadjusted reference range for healthy children. When the mcv is 100 fl, macrocytic the latter occur in macrocytic anemia. These oral lesions typically occur at the time when folate depletion is severe enough to cause megaloblastic anemia, although, occasionally, lesions.
It is a common condition that can be caused by inadequate rbc production, excessive rbc destruction, or blood loss. When the tissues do not receive an adequate amount of oxygen, many organs and functions are affected. Anemia is defined by a hemoglobin hgb value at least two standard deviations below the mean for age and sex for men and for women. A practical approach to the differential diagnosis and evaluation of the adult patient with macrocytic anemia. Megaloblastic anemia testing algorithm arup consult. An initial workup includes testing vitamin b12 and folate levels. Cause medicine mnemonics study using the knowmedge abim internal medicine and usmle step question bank.