UAMS HEMATOLOGY EXAMS SCRIPT QUESTIONS AND
ANSWERS GRADED A+
✔✔Which macrocytic anemia commonly has oval macrocytes - megaloblastic or non-
megaloblastic? - ✔✔Megaloblastic.
Non-megaloblastic normally has round macrocytes.
✔✔In megaloblastic anemia, the defect in in DNA replication from a depletion of what? -
✔✔Thymidine triphosphate
✔✔What is asynchrony? - ✔✔When the nucleus and cytoplasm are developing at
different rates and do not match.
In megaloblastic anemia, the nuclear maturation is stunted due to impaired DNA
synthesis, which causes it to have an abnormal appearance while the cytoplasm is
maturing normally.
✔✔Who is most likely to have a Vitamin B12 deficiency? - ✔✔Vegans
Most of the B12 in our diets come from meat, dairy products, and eggs.
✔✔How is B12 absorbed into our system? - ✔✔Intrinsic factor, which is produced by the
parietal cells of the stomach
✔✔How is Vitamin B12 deficiency diagnosed? - ✔✔Vitamin assay
✔✔What are some causes of B12 deficiency? - ✔✔-Lack of intrinsic factor (cannot be
absorbed)
-Inflammation or surgery involving stomach or small intestines
-Fish tapeworm (Diphyllobothrium latum)
-Strict veganism
✔✔What is pernicious anemia (PA)? - ✔✔PA is a TYPE of B12 deficiency anemia. PA
is specifically caused by the lack of intrinsic factor because of an autoimmune disorder
that targets the parietal cells. This means the B12 cannot be absorbed from our
stomach.
✔✔How is pernicious anemia diagnosed? - ✔✔Anti-Parietal cells or Anti-Intrinsic assay
✔✔How is pernicious anemia treated? - ✔✔Injections of vitamin B12
-Oral supplements would not help since it will still not be absorbed from the stomach
✔✔Which is more common and why - folate or B12 deficiency? - ✔✔Folate deficiency is
more common because there are no absorption issues with folate (except with
alcoholism). It depends almost entirely on the diet.
, Can also occur in pregnancy (increased need for folate), hemolytic anemia, and
leukemia (increased cell turnover).
✔✔How is folate deficiency anemia treated? - ✔✔Folic acid oral supplements
✔✔True or False: Chemotherapy and myelodysplasia/premalignant "megaloblastoid"
can also cause megaloblastic anemia. - ✔✔True
✔✔What are some common symptoms of megaloblastic anemia? - ✔✔Tachycardia,
shortness of breath, lemon-yellow pallor, smooth and sore tongue
✔✔What are some symptoms unique to B12 deficiency? - ✔✔Neurologic
manifestations, tingling and numbness of extremities, gait abnormalities, and psychosis
✔✔Which is usually more severe - B12 or folate deficiency anemia? - ✔✔B12 deficiency
anemia
✔✔How are the RBC, WBC, and PLT counts usually affected with megaloblastic
anemia? - ✔✔All decreased
✔✔What will the MCV be in megaloblastic anemia? - ✔✔Increased, >100 fL
✔✔Will there be increased or decreased reticulocytes with megaloblastic anemia? -
✔✔Decreased
✔✔What abnormal WBC morphology can be seen with megaloblastic anemia? -
✔✔Hypersegmented neutrophils
If 5 cells with more than 5 lobes are seen in a diff, hypersegmentation can usually be
called
✔✔Is the bone marrow hypocellular or hypercellular in megaloblastic anemia? -
✔✔Hypercellular, but the cells usually don't survive and undergo intramedullary
hemolysis or ineffective erythropoiesis.
✔✔What abnormal RBC morphology can be seen with megaloblastic anemia? -
✔✔Macro-ovalocytes
✔✔What are some abnormalities seen in the bone marrow of someone with
megaloblastic anemia? - ✔✔RBC hyperplasia (M:E ratio 1:1)
Asynchrony
Karyorrhexis (degenerating/pyknotic cells)
Moth-eaten nuclei
Giant bands and metamyelocytes
ANSWERS GRADED A+
✔✔Which macrocytic anemia commonly has oval macrocytes - megaloblastic or non-
megaloblastic? - ✔✔Megaloblastic.
Non-megaloblastic normally has round macrocytes.
✔✔In megaloblastic anemia, the defect in in DNA replication from a depletion of what? -
✔✔Thymidine triphosphate
✔✔What is asynchrony? - ✔✔When the nucleus and cytoplasm are developing at
different rates and do not match.
In megaloblastic anemia, the nuclear maturation is stunted due to impaired DNA
synthesis, which causes it to have an abnormal appearance while the cytoplasm is
maturing normally.
✔✔Who is most likely to have a Vitamin B12 deficiency? - ✔✔Vegans
Most of the B12 in our diets come from meat, dairy products, and eggs.
✔✔How is B12 absorbed into our system? - ✔✔Intrinsic factor, which is produced by the
parietal cells of the stomach
✔✔How is Vitamin B12 deficiency diagnosed? - ✔✔Vitamin assay
✔✔What are some causes of B12 deficiency? - ✔✔-Lack of intrinsic factor (cannot be
absorbed)
-Inflammation or surgery involving stomach or small intestines
-Fish tapeworm (Diphyllobothrium latum)
-Strict veganism
✔✔What is pernicious anemia (PA)? - ✔✔PA is a TYPE of B12 deficiency anemia. PA
is specifically caused by the lack of intrinsic factor because of an autoimmune disorder
that targets the parietal cells. This means the B12 cannot be absorbed from our
stomach.
✔✔How is pernicious anemia diagnosed? - ✔✔Anti-Parietal cells or Anti-Intrinsic assay
✔✔How is pernicious anemia treated? - ✔✔Injections of vitamin B12
-Oral supplements would not help since it will still not be absorbed from the stomach
✔✔Which is more common and why - folate or B12 deficiency? - ✔✔Folate deficiency is
more common because there are no absorption issues with folate (except with
alcoholism). It depends almost entirely on the diet.
, Can also occur in pregnancy (increased need for folate), hemolytic anemia, and
leukemia (increased cell turnover).
✔✔How is folate deficiency anemia treated? - ✔✔Folic acid oral supplements
✔✔True or False: Chemotherapy and myelodysplasia/premalignant "megaloblastoid"
can also cause megaloblastic anemia. - ✔✔True
✔✔What are some common symptoms of megaloblastic anemia? - ✔✔Tachycardia,
shortness of breath, lemon-yellow pallor, smooth and sore tongue
✔✔What are some symptoms unique to B12 deficiency? - ✔✔Neurologic
manifestations, tingling and numbness of extremities, gait abnormalities, and psychosis
✔✔Which is usually more severe - B12 or folate deficiency anemia? - ✔✔B12 deficiency
anemia
✔✔How are the RBC, WBC, and PLT counts usually affected with megaloblastic
anemia? - ✔✔All decreased
✔✔What will the MCV be in megaloblastic anemia? - ✔✔Increased, >100 fL
✔✔Will there be increased or decreased reticulocytes with megaloblastic anemia? -
✔✔Decreased
✔✔What abnormal WBC morphology can be seen with megaloblastic anemia? -
✔✔Hypersegmented neutrophils
If 5 cells with more than 5 lobes are seen in a diff, hypersegmentation can usually be
called
✔✔Is the bone marrow hypocellular or hypercellular in megaloblastic anemia? -
✔✔Hypercellular, but the cells usually don't survive and undergo intramedullary
hemolysis or ineffective erythropoiesis.
✔✔What abnormal RBC morphology can be seen with megaloblastic anemia? -
✔✔Macro-ovalocytes
✔✔What are some abnormalities seen in the bone marrow of someone with
megaloblastic anemia? - ✔✔RBC hyperplasia (M:E ratio 1:1)
Asynchrony
Karyorrhexis (degenerating/pyknotic cells)
Moth-eaten nuclei
Giant bands and metamyelocytes
