Bioquimica

Applying the Basic Sciences to Clinical Medicine.

Part 1: Approach to Learning Biochemistry

Part 2: Approach to Disease

Part 3: Approach to reading

A 47-years-old female is brought to theemergency department with complaints of malaise, nausea and vomiting, and fatigue. The patient reveals a long history of alcohol abuse for the last 10 years requiring drinks daily especially in themorning as an “eye opener”. She has been to rehab on several occasions for alcoholism but has not been able to stop drinking. She is currently homeless and jobless. She denies cough, fever, chills,upper respiratory symptoms, sick contacts, recent travel, hematemesis, or abdominal pain. She reports feeling hungry and has not eaten very well in a long time. On physical exam she appears malnourishedbut in no distress. Her physical exam is normal. Her blood count reveals a normal white blood cell count but does show an anemia with large red blood cells. Her amylase, lipase, and liver functiontests were normal.

What is the most likely cause of her anemia?

What is the molecular basis for the large erythrocytes?

Summary: 47-year-old- alcoholic white female has fatigue, malaise, nausea,vomiting and poor nutritional intake whit macrocytic anemia and no evidence of pancreatitis, liver disease, or peptic ulcer disease.

Cause of anemia: Folic acid deficiency.

Molecular basis ofmacrocytosis: Abnormal proliferation of erythroid precursors in the bone marrow, since folate deficiency encumbers the maturation of these cells by inhibition of deoxyribonucleic acid (DNA) synthesis.Refer to the following list of vitamins:

A.-Ascorbic acid(vitamin C) E.-Niacin (vitamin B3)
B.-Biotin F.-Pantothenicacid
C.-Cobalamin (vitamin B12) G.-Riboflavin(Vitamin B2)
D.-Folic acid H.-Thiamine (vitamin B1)

For each patient, select the...