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By ULY CLINIC

 

Megaloblastic Anemia

 

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.

 

Diagnostic Criteria

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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 and ataxic gait.

 

Investigations

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  • 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 

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Pharmacological Treatment

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  • 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 

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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 

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Updated on, 27.10.2020

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References

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1. STG page number 18-19

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