A nurse is assessing a patient with suspected folate-deficiency anemia. Which assessment finding would be most characteristic of this condition?
1Megaloblastic red blood cells on peripheral blood smear✓ 정답
2Microcytic, hypochromic red blood cells on smear
3Sickle-shaped red blood cells on peripheral smear
4Spherocytic red blood cells on peripheral smear
해설
Folate-deficiency anemia is characterized by megaloblastic RBCs on peripheral smear due to impaired DNA synthesis. Other options represent findings of iron-deficiency anemia (microcytic), sickle cell disease, or hereditary spherocytosis.
Clinical Judgment
This question assesses your ability to distinguish the characteristic findings of different causes of anemia. The key is the pathophysiological understanding that folate deficiency impairs DNA synthesis, disrupting the maturation of red blood cell precursors in the bone marrow. The most characteristic finding on a peripheral blood smear is the observation of megaloblastic red blood cells. The other options are findings seen in anemias from other causes, such as iron deficiency, sickle cell disease, and hereditary spherocytosis.
Memory Tip: Both folate deficiency and vitamin B12 deficiency cause Megaloblastic anemia. "Mega" means large, so the cells appear large (Macro). In contrast, iron deficiency makes cells appear small (Micro).
KR vs US: In Korea, the focus for the main causes of folate deficiency tends to be more on alcoholism, malabsorption, and medications (like methotrexate) rather than nutritional deficiency alone. The US NCLEX emphasizes a comprehensive assessment of various risk factors, including nutritional status, pregnancy, and alcohol intake.
임상 시나리오
Clinical Practice Guide
When evaluating a patient suspected of having folate deficiency anemia, you should thoroughly assess dietary history (insufficient intake of green leafy vegetables and fortified grains), alcohol consumption history, malabsorption disorders (celiac disease, Crohn's disease), and medication history (methotrexate, trimethoprim, phenytoin). In blood tests, check serum folate levels along with increased MCV (>100 fL).
Caution: In SATA (Select All That Apply) questions asking about "characteristics of folate deficiency anemia," neurological deficits (numbness/tingling in hands and feet, gait disturbance) are generally symptoms seen in vitamin B12 deficiency, so they may be presented as a trap. Folate deficiency can involve tongue pain (glossitis) or inflammation of the tongue, but not severe neurological symptoms.
핵심 개념
Megaloblastic Anemia — Anemia caused by the production of abnormally large and immature red blood cell precursors (megaloblasts) in the bone marrow due to impaired DNA synthesis. The main causes are folate or vitamin B12 deficiency.
Macrocytosis — A condition where the average size of red blood cells (MCV) is larger than normal. It can occur in folate/vitamin B12 deficiency, liver disease, alcoholism, hypothyroidism, etc.
Peripheral Blood Smear — Peripheral blood smear test. This test involves spreading a blood sample on a slide and observing it under a microscope to evaluate the size, shape, and hemoglobin content of red blood cells, as well as the morphology of white blood cells and platelets, aiding in the diagnosis of various blood disorders.
Folate (Vitamin B9) — A water-soluble vitamin essential for DNA synthesis and cell division. It is abundant in green leafy vegetables, fruits, and fortified grains. Deficiency causes megaloblastic anemia.
Hypochromic — Hypochromic. A condition where the hemoglobin concentration inside red blood cells is low, causing the central pallor to widen and appear pale. This is a characteristic finding of iron deficiency anemia.