Anemia megaloblástica

1. Central University of Ecuador Carlos Andrade Marín Hospital Megaloblastic A nemia Juan Carlos Ayala Sandoval 2013

2. COBALAMIN 5-deoxyadenosylcobalamin ( ado ) CoA Methyl-manolilmutasa Methylcobalamin Methionine-synthase H ydroxocobalamin

3. F ood source and requirements Western Food : 5-30pg/día Elimination : 1-3 pg /día B ody Reserves: 2-3 mg

4. A bsorption

5. Transport

6. FOLATE F olic Acid F olate precursor compound R educed to DHF or THF C ontaining one carbon unit Folate polyglutamates N utritional content : >100 pg /100 g Western Food : 250 pg /día D aily requirements : 100 pg Body Reserves: 10 mg

7. Absorption

8. Transport 1/3 Albumin 2/3 Free B ody fluids : 5-MTHF monoglutamate Folate receptor high affinity Folate membrane transporter

9. CLINICAL FEATURES

10. General tissue effects of cobalamin and folate deficiences

11. General tissue effects of cobalamin and folate deficiences

12. HEMATOLOGIC FINDINGS

13. HEMATOLOGIC FINDINGS

14. CAUSES OF COBALAMIN DEFICIENCY

15. DIAGNOSIS OF COBALAMIN DEFICIENCIES

16. CAUSES OF FOLATE DEFICIENCY

17. DIAGNOSIS OF COBALAMIN DEFICIENCES

18. DIAGNOSIS OF FOLATE DEFICIENCES

19. TREATMENT – MEGALOBLASTIC ANEMIA Platelets > 800 X109 /L

20. TREATMENT OF COBALAMIN DEFICIENCY

21. Hydorxocobalamin Replenishment of body stores S ix 1000 µg IM/3-7 days Maintenance therapy 1000 µg IM / month for 3 months Cyanocobalamin ( Poorer retention )

22. TREATMENT OF FOLATE DEFICIENCY

23. FOLINIC ACID Stable form of fully reduced folate Toxic efects of Methotrexate DHF reductasa inhibitors

24. PROPHYLACTIC FOLIC ACID