MEGALOBLASTIC ANAEMIA/

MACROCYTIC ANAEMIA
Ihsanil husna
ETIOLOGY

 Inadequate intake
 Vitamin B12 deficiency

 Folic acid deficiency

CAUSES

Vtamin B12 deficiency Folic acid deficiency

Inadequate intake;
Vegan diet
Inadequate intake:
Intrinsic fc deff: infancy,elderly,alcohol
Pernicious anaemia ics,food fads
gastrectomy(partial/total)
congenital intrinsic fc deff
Malabsorbsion: coeliac
Small intestine disease disease, dermatitis
*bacteriql overgrrowth herpetiformis,tropical
*Crohn disease& resection of
terminal ileum sprue
tropical sprue Increased utilization or
fish tapeworm
HIV,severe severe pancreatic
loss:physiologic;
disease Prematurity,lactation
drugs:NO,colchicine,neomycine
CLINICAL FINDINGS

 Less of symptoms
 Likely occure in individuales who donot consume
meat/dairy product
 malnutrition

 MCV ( mean corpuscular volume ) >100

 Haemoglobine < 10 g/dl

LABORATORY FINDINGS
 Normal RDW,macrocytosis,often with target
cells& 0r stomatocytes
 Raised gamma glutamyltransferase confirms
alcohol effect
 Oval macrocytis signify a disorder of RBC
production
 Hypersegmented neutophils are present, B12 /
folate deff
LABORATORY TEST

 parietal cell,inrinsic fc and tyroid antibody

 B 12 levels <100 ng/l

 Schilling test for B12 absorbsion

 Endoscopy to exclusion of gastric carsinoma in

GIT symptoms
FOLIC ACID (CONT..)
pathology

 Increase urinary loss  Blood disorder:

 Acute liver disease,
congestive heart
failure
 Homocystinuria
 Antifolate drugs
 Methotrexate,
pirimethamine,trimeth
oprim, anticonfulsant
drugs
 Haemolytic
anaemia,myelofibrosis
 Malignancy
 Dialysis
 Severe inflamatory
disease (particularly
exfol skin idsorder0
Crohn’s dis
MANAGEMENT
 Vitamin B12 deff:
 Hydroxycobalamin 1 mg IM,alternating days for
5 days
 Maintenance dose 1 mg/3monthly

 Cyanocobalamin should not be used

 Pernicious anaemia should also be given oral iron

for 4 months
 Vegans; Cyanocobalamin 50 mg/day
FOLIC ACID

 Folic neuracid 5 mg/dy

 Durati to take to preon; long term in herited
haemolytic anaemia and myelofibrosis
 Pregnant women advised to take folic acid
supplement to prevent neural tube deffects