Megaloblastic anemia

1. MEGALOBLASTIC ANEMIA

2. Contents Introduction Causes Symptoms Diagnostic Test Confirmatory Test Treatment Prevention Case Study Conclusion References

3. Introduction Type of anemia. Produce very large size of red blood cell. Produce fewer cells. Oval in shape.

4. Causes Due to folate or cobalamin deficiency. Digestive disease. Malabsorption . Medication induced folic acid deficiency.

5. Symptoms Anemia Painful tingling of the hand and feet Decreased appetite Fatigue Weakness Irritability and status mental changes Weight loss

6. Diagnostic Test General finding from a medical history and physical examination. Complete blood count. Barium study of digestive system.

7. Confirmatory Test Schilling Test Two doses of Vitamin B12: small dose ( radiolabeled ) – orally larger dose (unlabeled) – intramuscularly. 24 hours urine collection.

8. Cont… Bone marrow biopsy Deficiency of Vitamin B12 or folic acid decreased DNA synthesis slows nuclear maturation. Cytoplasmic maturation is advanced.

9. Cont… Figure 1: The impaired nuclear maturation is seen as open, loose, immature chromatin.

10. Treatment Correct the condition. The underlying cause identified adequate long term treatment. Vitamin B12 injections: Daily for 1 week Weekly for 4 weeks Monthly till levels are stabilized Oral Vitamin B12.

11. Prevention Restricted alcohol consumption. Adequate intake of food containing Vitamin B 12 and folic acid.

12. Case Study A Breast-fed Newborn With Megaloblastic Anemia -treated With the Vitamin B12 Supplementation of the Mother

13. History A full-term female newborn weighing 2180g. Severe pallor and mild respiratory distress. Mother: Second pregnancy Vegan No vitamin B12 supplementation Intrauterine growth retardation.

14. Diagnostic Test Physical examination: Small for gestation age Pallor Mild tachypnea (65/min) Tachycardia (180/min) Cardiac murmur.

15. Cont… Neurological examination: Normal tonus and newborn reflexes. Laboratory diagnosis: Complete blood count: severe macrocytic anemia Hemoglobin : 7.6 mg/ dL (14-20 mg/ dL ) Hematocrit : 24.8% (42%-64%) Mean corpuscular volume: 125 fl (100-120 fl) Serum vitamin B12: 148 pg/ mL (293-1208 pg/ mL ) Serum folic acid: 6.5 ng / mL (1.5-16.9 ng / mL ).

16. Cont… Peripheral blood smear: - Significant megaloblastic alteration

17. Cont… - Nuclear- cytoplasmic asynchrony

18. Cont… - Anisocytosis and poikilocytosis

19. Cont… - Macrocytes

20. Cont… - Stomatocytes

21. Cont… - Target cells

22. Cont… - Normoblasts with clover-leaf nuclei

23. Treatment Erythrocytes transfusion. Intramuscular injection of vitamin B12 at 1000µg/d for 10 days. Followed by 1000 mg 3 times per week for 2 weeks. Subsequently at 1000 mg per week for 4 weeks. After this regimen, the mother received 1000 mg per month for 3 additional months. Newborn was fed exclusively with the breast milk.

24. Discharge Summary Vitamin B12 level progressively increased in both individuals. No neurologic sequelae . No anemia .

25. Conclusion Megaloblastic anemia rare blood disorder Caused by defect in absorption or inadequate intake of Vitamin B12 or folic acid Results low Vitamin B12 or folic acid in blood produce abnormal enlarged red blood cells.

26. References Omer Erdeve , MD, Saadet Arsan , MD,* Begum Atasay , MD, Talia Ileri , MD, and Zumrut Uysal , MD. (2009). A Breast-fed Newborn With Megaloblastic Anemia-treated With the Vitamin B12 Supplementation of the Mother. Pediatric Hematology Oncology. 31:763–765. HealthLineInfo . Megaloblastic Anemia. [Online] Available from: http://healthlineinfo.com/megaloblastic-anemia-symptoms-diagnosis-and-treatment.html The Health and Disease Blog. Schilling Test. [Online] Available from: http://thehealthanddiseaseblog.blogspot.com/2011/10/schilling-test-what-is-it-principle.html#gsc.tab=0 FreeMD . Megaloblastic Anemia. [Online] Available from: http://www.freemd.com/megaloblastic-anemia/prevention.htm