Chapter 5 Megaloblastic anaemias and other macrocytic

anaemias

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5.1 Which ONE of the following supplements is used therapeutically?

A Adenosylcobalamin

This is an unstable form that is not used clinically.

B Polyglutamate folate

This is a natural form of folate in the diet, but the fully oxidized monoglutamate form of folate, folic acid, is
used in dietary supplements.

C Hydroxocobalamin

Commonly used to treat vitamin B12 deficiency. This is also the type of vitamin B12 found in food.

D Methyltetrahydrofolate

This is the form of folate used at the cellular level for regulation of homocysteine and for DNA reproduction.

5.2 Which ONE of the following is associated with pernicious anaemia?

A Ileal resection

Although this can be a cause of vitamin B12 deficiency due to malabsorption, pernicious anaemia is due to
deficiency of a different aetiology.

B Elevated serum gastrin

C Pregnancy

Vitamin B12 needs are higher during pregnancy, but pernicious anaemia is a specific diagnosis.

D Malabsorption of B12–intrinsic factor complex

The problem in pernicious anaemia is with production of intrinsic factor due to anti-parietal cell or anti-
intrinsic factor antibodies, not malabsorption.

5.3 Which ONE of these statements is TRUE concerning the reduction of folate?

A The biochemical reaction requires vitamin B12

B Reduction is inhibited by sulphonamide

C Reduction is inhibited by methotrexate

D Reduction occurs during thymidylate synthesis

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 Which ONE of the following drugs causes folate deficiency?
5.4

A Valproic acid

The mechanism is not clear.

B Metformin

This causes B12 deficiency.

C Prednisolone

This is not a known cause of folate deficiency.

D Zinc gluconate

Excessive use can cause copper deficiency.

5.5 Causes of microcytic red cells include which ONE of the following?

A Alcohol

Red cells are usually larger (macrocytic).

B Renal disease

Typically normocytic red cells.

C α-Thalassaemia

D Increased reticulocyte count

Reticulocytes are larger than mature red cells and so the mean corpuscular volume (MCV) is increased.

5.6 Which ONE of the following statements is TRUE about megaloblastic anaemia?

A It is always caused by vitamin B12 or folate deficiency

There are rare inborn metabolic errors that cause it.

B Bone marrow appearances are distinct in vitamin B12 or folate deficiency

They are identical.

C It is caused by defective DNA synthesis

D It may be caused by nitric oxide

Nitrous not nitric oxide inhibits B12 metabolism and causes megaloblastic anaemia.

5.7 Which ONE of the following is caused by folate deficiency?

A Spinal cord posterior column degeneration

This is a consequence of severe vitamin B12 deficiency.

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 B Haemolytic anaemia

C Neural tube defect

It is associated with folate deficiency in the mother.

D Duodenal atrophy

5.8 Which ONE of the following can contribute to vitamin B12 deficiency?

A Haemolytic anaemia

This may lead to folate deficiency.

B Veganism

If all animal products are avoided.

C Metastatic carcinoma

D Jejunal resection

Because B12 is absorbed through the ileum.

5.9 Which ONE of the following clinical findings is caused by vitamin B12 deficiency?

A Vitiligo

Although vitiligo is sometimes seen in association with pernicious anaemia, it is a result of a separate
autoimmune process.

B Cerebellar ataxia

C Dementia

D Abnormal liver function

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