Macrocytic anemia¶

graph TD
    X[Macrocytic Anemia] ==> X1["`Megalob;astic Anemia due to B~12~ or folate deficiency `"] & X2[Macro-cytic anemia
    due to alcohol,liver disease,drugs]

Megaloblastic Anemia¶

One less Cell Division

Folate or Vitamin B₁₂ deficiency ➡️ Cell cannot Divide ➡️ Macrocytic RBC.

Normal Folate and B12 Pathway¶

Symptoms¶

Problems in all rapidly multiplying cells

MEgaloblastic Anemia¶

Glostitis(⬇️ Rapid replacement of tongue squamours cells ➡️ cell waiting ➡️ enlargement)
Atropic GAstritis( due to Pernicius anemia ➡️ adenocarcinoma)
Hypersegmented Neutrophils
if ⬇️ folate = ⬇️serum folate , ⬆️ Homocysteine
if ⬇️ Vitamin B₁₂ = ⬇️Serum vitB₁₂,⬆️Homocyteine ,⬆️ Methyl-Manolnoic acid.

graph TD
    X[Megalobastic ANemia] ==> X1[Folate Deficiency] & X2["`Vitamin B~12~ defcienct`"]

	Folate deficiency	Vitamin B₁₂ deficiency
Stores	depleted in months	Years to deplete from liver stores
Deficency casuse	high demand(Pregnancy,haemolytic anemia, Cancer)	Autoimmune(Pernicious anemia)
	poor dies	Damage to Parietal Cell,Poor diet in vegans
	ALcoholic	Damage to ileum
	Methotrexate DHF reductase inhibitors
Special lab	low serum folate
	high Homocysteine	high Homocysteine
	Normal MethylMalonic acid	high methyl-manalonic acid
	FIGLU test	Schilling Test
Special Symptoms		Sub-acute combines degeneration of Spinal cord (Methyl-malanoic acid destruction of Myelin sheath)
		Hyper-pigmentation of Knuckles

Types of Pernicious anemia

graph TD
    X[types of Pernicius anemia] ==> X1[Type 1] & X2[type 2] & X3[Type 3 ]
    X1 -.->|"`antibodies in lumen for Vitb12 and R-binder`"| X1a["`Inhibits binding of VitB~12~ to INtrinsic factors`"]
    X2 -.->|"`antibodies in lumen against VItB~12~ - Intrinsic factor`"| X2a["`Inhninbit binding of vitB~12~ - intrinsic factor to ileum`"];
    X3 -.-> X3a[autoimmune destruction of Parietal cells]