?????? Megaloblastic Anemia

1
??????Megaloblastic Anemia
2
????

• 1. ??
• ?????Vit B12????DNA??????????

2. ?? (1)???? (2)???? (3)???? (4)????????
3
??????

• ?????????,?????
• ?????
• ??????

4
???????

• (?)?? ??
• (?)?????
• (?)??? Vit B12??
• ???????????,????
• ??Vit B12lt100140ng/ml(74103pmol/L)
• ???????lt227nmol/L(lt100ng/ml)
• 
  ???

5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
MA?????????,?????????????????????????????????????
??????????????
9
MA??????????????Howell-Jolly??,???????????Cabot??
?????????????????
10
MA?????????????????????????,????????????


??
11
(No Transcript)
12
MA?????????????
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
MA?????????,?????????????????????????,???????????
?
18
MA???????????????????????????,????????5?Howell-Jo
lly???
19
MA??????????????????,??????????4?Howell-Jolly???
20
MA??????????????????,????????????
21
MA???????????????????
22
??
MA????????????????????????????(????),????????????
?
23
?????

• ??????lt6.81nmol/L(lt3ng/ml) ,
• ???????lt227nmol/L,????????????????????

24
(?)??

• ????HBV?HCV??????

25
(?)???????????

• 1.????
• (1)??????????
• (2)??????,?????????,???????????????
• (3)??????,??????B12????

26

• 2.?????
• (1)?????,???????(MCV)gt100fl,??????????
• (2)??????????,?????????
• (3)?????????????
• (4)????,????lt6.81nmol/L,?????lt227nmol/L
• (5)?????B12??lt74103pmol/L,???????lt227nmol/L
• (6)?????B12 ??lt29.6pmol/L
• (7)???????????
• (8)???????????B12??????,24?????B12???lt10?

27

• ????
• 1?(1)?(2),?2?(1)?(3)?(2)?(4)???????????????
• ??1?(1)?(2),?2?(1)?(3)?(2)?(5)???????B12?????????
  
• ????1?(1)?(2)?(3),?2?(1)?(3)?(6)?(7)????????,(8)?
  ?????

28
??

• MDS-RA?AML-M6
• ????????????????,?AA??
• ??
• Vit B12??????????
• ??

29
??

• 1.????
• ????
• (1)???B12???
• (2)?????

30
????

• ????

1.?????????????????????????????,???????????????
????
2. ?????????????????????????30g/L???????????
3.????????????????????????
31
Case 1
83-year-old man admitted to hosptical complaining
of increasing weaken.LabHb 73.0g/L,MCV
144.0fl,MCHC 324g/L,RDW not available.Serum B12
levellt100pg/ml(lt74pmol/L)LLN at reference lab
250 pg/ml(185pmol/L).Serum and red-cell folates
normal.DIAGNOSISsevere megaloblastic anemia due
to vitamin B12 deficiency.Field shows marked
anisocytosis.Given an MCV of 144.0fl,it is likely
that most cells in this field are macrocytes.
32
Giant oval macrocyte.At lest two of the other
cells in this field are macrocytic,given an MCV
of 144.0fl(x500).
33
Oval and round macrocytes.Nonspecific
poikilocytes x3 also present(x500).
34
Marked anisocytosis.Note stark contrast between
tiny microcytes x2 and large classic oval
macrocytes x4(x500).
35
Oval macrocytes x2 with schistayte(x500)
36
Scattered macroovalocytes.
37
Array of hypersegmented neutrophils(x500).
38
????

• ?,61?????????????4???
• ????36?,??94?/?,??19?/?,??14/8kPa,????,?
  ???,?????,??,??????????,????,???????????,??????,??
  ??,??94?/?,????,???????????,??,???,?????,??????,??
  ?????

39

• ?????
• ?? ???2.6109/L?????68g/L????1.541012/L???????
  ?138.2fl?MCH44.2pg?MCHC342g/L,???41109/L,?????0.0
  18,Hct0.21,???572.6ug/L(???16.4323.00ug/L),???B12
  ?0(???1871059ng/L),??5.5pg/L(???2.918.7pg/L)???
  ????????????????,HP(-)?B??????,??????????????
  ???,??????? ?2.1/1,???40,??????,??????,???19,???
  ?????,??????????4?,??????

40
? ?

• ????????,????????? ?
  ????????
• ,????????
  
• ?

???B12
??
????????
????????
41

• ???????????
• A??????
• B???????????
• C?????
• D?????
• E??????

E
42

• ????????????????
• A??????????
• B?????????????????
• ??
• C??????????????
• D???????????????
• E????????????????

B