• Type of anemia.
• Produce very large size of red blood cell.
• Produce fewer cells.
• Oval in shape.
• Due to folate or cobalamin deficiency.
• Digestive disease.
• Medication induced folic acid deficiency.
• Painful tingling of the hand and feet
• Decreased appetite
• Irritability and status mental changes
• Weight loss
• General finding from a medical history and
• Complete blood count.
• Barium study of digestive system.
i. Schilling Test
• Two doses of Vitamin B12:
- small dose (radiolabeled) – orally
- larger dose (unlabeled) –
• 24 hours urine collection.
ii. Bone marrow biopsy
• Deficiency of Vitamin B12 or folic acid
decreased DNA synthesis slows
• Cytoplasmic maturation is advanced.
Figure 1: The impaired nuclear maturation is
seen as open, loose, immature
• 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.
• Restricted alcohol consumption.
• Adequate intake of food containing
Vitamin B12 and folic acid.
A Breast-fed Newborn With
With the Vitamin B12
Supplementation of the Mother
A full-term female newborn weighing
Severe pallor and mild respiratory distress.
⁻ Second pregnancy
⁻ No vitamin B12 supplementation
⁻ Intrauterine growth retardation.
- Small for gestation age
- Mild tachypnea (65/min)
- Tachycardia (180/min)
- Cardiac murmur.
• Erythrocytes transfusion.
• Intramuscular injection of vitamin B12 at
1000µg/d for 10 days.
• Followed by 1000 mg 3 times per week for 2
• 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.
• Vitamin B12 level progressively increased in
• No neurologic sequelae.
• No anemia.
• 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
• 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.
• HealthLineInfo. Megaloblastic Anemia. [Online] Available from:
• The Health and Disease Blog. Schilling Test. [Online] Available from:
• FreeMD. Megaloblastic Anemia. [Online] Available from: