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Megaloblastic Anemia

Megaloblastic Anemia
Megaloblastic Anemia
Megaloblastic Anemia
Megaloblastic Anemia

Introduction

This is a condition whereby the bone marrow usually produces large, structurally abnormal, immature red blood cells (megaloblasts) often due to inadequate intake or malabsorption of vitamin B12 or folate.

Risk Factors

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Signs and symptoms

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Diagnostic criteria

• Pallor
• Depression
• Hair loss
• Pins and needles, numbness in hands or feet
• Tremors and palsies
• Mildly jaundiced (lemon yellow tint),
• Beefy tongue,
• Darkening of palms
• Ataxic gait.

Investigations

• FBC-Low Hb, sometime pancytopenia, raised mcv but maybe low normal if coexisting with iron deficiency
• Peripheral smear-oval macrocytes, hyper segmented neutrophils
• Serum vitamin B12 maybe low or normal, Serum folate level, TSH, U+Es, LFT
• Raised reticulocyte count
• Bone marrow studies may be indicated

Treatment

  • Non-pharmacological

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  • Pharmacological

    • Vitamin (B12 deficiency anaemia) and other macrocytic without neurological involvement
    • Hydroxycobalamine, initially 1 mg IM 3 times a week for 2 weeks then 1mg every 3months
    • Clinically review every 2 months with or without serum B12 and if clinically indicated increase the frequency to every 2 months or every month

    Pernicious Anaemia (B12 deficiency) with neurological symptoms and signs

    • Hydroxycobalamine, initially 1 mg IM on alternate days until no further improvement (maximum reversal or neuro-psychiatric signs and symptoms are achieved) then 1mg every 2 months

    NOTE:

    • Folic acid 5mg (PO) once daily for least 2 months this must be started simultaneously with injection vitamin B12
    • Ferrous Sulphate 200mg 8 hourly for at least 3 months

Prevention

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Updated on,

14 Novemba 2020 10:56:36

References

    1. STG
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