Megaloblastic anemia

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  • Result: Normal: 8-40% radiolabeled Vitamin B12 in urineAbnormal: <5-7% radiolabeled Vitamin B12 urine
  • Megaloblastic anemia

    1. 1. MEGALOBLASTIC ANEMIA
    2. 2. Contents Introduction Causes Symptoms Diagnostic Test Confirmatory Test Treatment Prevention Case Study Conclusion References
    3. 3. Introduction • Type of anemia. • Produce very large size of red blood cell. • Produce fewer cells. • Oval in shape.
    4. 4. Causes • Due to folate or cobalamin deficiency. • Digestive disease. • Malabsorption. • Medication induced folic acid deficiency.
    5. 5. Symptoms • Anemia • Painful tingling of the hand and feet • Decreased appetite • Fatigue • Weakness • Irritability and status mental changes • Weight loss
    6. 6. Diagnostic Test • General finding from a medical history and physical examination. • Complete blood count. • Barium study of digestive system.
    7. 7. Confirmatory Test i. Schilling Test • Two doses of Vitamin B12: - small dose (radiolabeled) – orally - larger dose (unlabeled) – intramuscularly. • 24 hours urine collection.
    8. 8. Cont… ii. Bone marrow biopsy • Deficiency of Vitamin B12 or folic acid decreased DNA synthesis slows nuclear maturation. • Cytoplasmic maturation is advanced.
    9. 9. Cont… Figure 1: The impaired nuclear maturation is seen as open, loose, immature chromatin.
    10. 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. 11. Prevention • Restricted alcohol consumption. • Adequate intake of food containing Vitamin B12 and folic acid.
    12. 12. Case Study A Breast-fed Newborn With Megaloblastic Anemia-treated With the Vitamin B12 Supplementation of the Mother
    13. 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. 14. Diagnostic Test  Physical examination: - Small for gestation age - Pallor - Mild tachypnea (65/min) - Tachycardia (180/min) - Cardiac murmur.
    15. 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. 16. Cont…  Peripheral blood smear: - Significant megaloblastic alteration
    17. 17. Cont… - Nuclear-cytoplasmic asynchrony
    18. 18. Cont… - Anisocytosis and poikilocytosis
    19. 19. Cont… - Macrocytes
    20. 20. Cont… - Stomatocytes
    21. 21. Cont… - Target cells
    22. 22. Cont… - Normoblasts with clover-leaf nuclei
    23. 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. 24. Discharge Summary • Vitamin B12 level progressively increased in both individuals. • No neurologic sequelae. • No anemia.
    25. 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. 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
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