presented by HAFIZ M WASEEM university of education LAHORE Pakistan i am from mailsi vehari and studied in lahore bsc in science college multan msc from lahore

1. Topic : MegaloblasticAnemia

2. HAFIZ M WASEEM UNIVERSITY OF
EDUCATION LAHORE

3. Content
• Introduction
• Etiology of megaloblastic anemia
• Pathophysiology
• Clinical presentation of megaloblastic anemia
• Labortary Diagonosis
• Sources of vitamin B12 and folic acid
• Discharge summary
• Conclusion
• References

4. MEGALOBLASTIC ANEIMA
• Definition
• Megaloblastic anemia is a general term used to
describe a group of anemia caused by impaired DNA
synthesis. It is characterized by abnormal findings in
peripheral blood smear and bone marrow samples.
Megaloblastic ,the hallmark of these anemia , are
caused by asynchronous maturation between the
nucleus and the cytoplasm due to DNA synthesis
impairment.

5. AETIOLOGY
Vitamin B12 deficiency or defective
metabolism
Folate deficiency or defective
metabolism
Drug induced (purine and pyramidine
analogs).

6. Vitamin B12 Deficiency
• Inadequate Intake:
• This is common among pure vegetarians , old and bed
ridden patients.
• Inability to absorb vitamin B12 Deficiency:
• After gastric surgery, lack of hydrochloric acid in gastric
juice, lack of intrinsic factor due to auto antibodies to
parietal cells.
• Drug Inhibition: Metformin proton pump inhibitor.

7. Continue…
• vitamin B12 or folate is deficient , thymidine
synthase function is impaired and DNA synthesis is
interrupted but RNA synthesis remains unimpaired.
• The inability to synthesize DNA leads to ineffectual
erythropoiesis is resulting in excess hemoglobin and
enlarged erythroid precursors being produced.
• The developing red cells has difficulty in
undergoing cell division but RNA continues to be
translated and transcribed into protein leading to
growth of the cytoplasm while the nucleus legs
behind.
• Often one or more cell division are skipped leading
to a larger than normal cell.

8. Clinical presentation
• Anemia symptoms
• Neurological symptoms
• Gasrtro-intestinal complain
• Symptoms Of Anemia:
• Weakness , palpitation ,fatigue , light-headedness , shortness
of breath , premature graying of hair , jaundice and pallor.
• Sever pallor and sight jaundice combine to produce
megaloblastic anemia.

9. Neurological symptoms
• The syndrome usually beings with paraesthesia in the feet and
fingers , difficulties in balance and walking.
• Vitamin B12 deficiency cause a demyelinization of the
peripheral nerves, the spinal cord , and the brain. Resulting in
more severs neurological symptoms.
• When it affects the spinal cord it causes spastic ataxiat
stiffness of the muscles with uncoordinated movement. At the
brain it results in dementia psychotic depression and paranoid
schizophrenia this has been termed “megaloblastic madness”

10. GASTRO-INTESTINAL
COMPLAINS
• Symptom include loss of appetite, glossitis, (red,
sore, smooth tongue) and diarhoea

11. LABORATORY DIAGNOSIS OF
MEGALOBLASTIC ANEMIAS
• Bone marrow smear:
• Bone marrow examination reveals myeloid cell
changes (giant bands, metamyelocytes and
hypertsegmentation) and megakariocytes are
decreased and show abnormal morphology.

12. SOURCES OFVITAMIN B12 AND
FOLIC
• Vitamin B12
• Meat, liver, kidney, clams, fish
• Eggs, cheese, and other dairy products
o Folic acid
• Green leafy vegetables
• Broccoli
• Fruit
• Whole grains
• Dairy products

13. Discharge summary
• Vitamin B12 level progressively increased In
both individuals.
1. No neurological sequelae
2. No Anemia

14. Conclusion

15. References
• www.researchgate.net
• www.slideshare.net
• www.britanncia.com