How are megaloblastic anemias treated?

Treatment of acquired forms of megaloblastic anemia

It is necessary to eliminate the cause that causes deficiency of vitamin B ₁₂ or folic acid (inefficient feeding, helminthic invasion, taking medications, infections, etc.).

When vitamin B deficiency is ₁₂

When vitamin B deficiency is _12, its drugs are prescribed - cyanocobalamin or oxycobalamin. The therapeutic dose (saturation dose) is 5 μg / kg / day in children up to a year; 100-200 mcg per day - at the age after a year, 200-400 mcg per day - in adolescence. The drug is administered intramuscularly once a day for 5-10 days before the reception of a regulocytaric crisis, and then every other day until hematological remission is obtained. The duration of the course is 2-4 weeks. In the presence of neurological manifestations, the vitamin is administered at a dose of 1000 μg per day intramuscularly for at least 2 weeks.

Criteria of treatment effectiveness

1. Reticulocytic crisis (an increase in the number of reticulocytes from day 3-4, the maximum increase in the number of reticulocytes on the 6th-10th day of treatment, the normalization of the number of reticulocytes by the 20th day, the degree of reticulocytosis is proportional to the degree of anemia).
2. Normalization of bone marrow hematopoiesis (by the 4th day of treatment).
3. Normalization of the picture of peripheral blood (improvement in red blood counts is noted from the end of the first week of therapy).
4. Reduction of neurologic symptoms from the 3rd day of treatment; full normalization in a few months.

Strengthen the therapy by administering the drug in a daily dose once a week for two months, then twice a month for six months and once every six months for several years.

If the cause of development in the _12- deficient anemia is eliminated, then there is no need for further therapy. If the cause of anemia persists or is not completely eliminated, annually supports preventive courses vitamin therapy in ₁₂ at a daily dose every other day for 3 weeks. Interruption of therapy after 10-18 months will lead to relapse of anemia, the early sign of which is the hyper-segmentation of neutrophil nuclei.

In the presence of an isolated deficiency of vitamin B ₁₂, folic acid is not advisable, since it has no effect in neurological symptoms and can even accelerate their development.

Against the backdrop of cobalamin treatment, iron and folate deficiency may develop, as they are consumed by proliferating tissues. In this regard, 7-10 days after the start of treatment, vitamin B ₁₂ can be supplemented with folic acid; iron preparations are prescribed after a decrease in CP to 0.8. If a patient has a polydeficiency anemia (for example, iron-vitamin B ₁₂ -deficit anemia in a vegetarian, a patient with a syndrome of the "caecum", etc.), therapy begins with the appointment of an iron preparation, and vitamin B ₁₂ is administered from the 3-4th week treatment and later. In severe anemia, vitamin A deficiency correction in ₁₂ can lead to acute hypokalemia, hypophosphatemia and hyperuricemia due to sharp activation of cell proliferation and metabolism of DNA and proteins.

Hemotransfusions are used only for hemodynamic disorders, coma.

Deficiency of folic acid

With a deficiency of folic acid, 1-5 mg of folic acid is administered orally every day for 3-4 weeks or several months, that is, until a new population of red blood cells is formed. The dose of folic acid in children of the first year of life is 0.25-0.5 mg / day. In the presence of malabsorption syndrome, the dose is 5-15 mg / day.

The number of reticulocytes begins to increase on the 2-4th day of treatment, the maximum recovery is noted on the 4-7th day of therapy. Normalization of hemoglobin level occurs at 2-6th week. The number of leukocytes and platelets increases in parallel with reticulocytosis. Normalization of bone marrow hematopoiesis occurs within 24-48 hours, but giant myelocytes and metamyelocytes can be observed for several days.

Prevention of megaloblastic anemia

Rational nutrition is a diet with mandatory consumption of meat, milk, liver, cheese, vegetables (tomatoes, lettuce, spinach, asparagus).

Purpose of folic acid in a dose of 5-10 mg / day in the last trimester of pregnancy, 1-5 mg per day for premature infants and children with malabsorption syndrome for 14 days.

Dispensary observation in the remission period

• Inspection of the hematologist once a month, during the first 6 months of observation; then once in 3 months for 1.5 years; the total observation period with the acquired forms is not less than 2 years.
• Clinical blood test with determination of the number of reticulocytes before each examination of the hematologist.

Supportive therapy courses for vitamin B ₁₂ (according to the scheme).

Correction of diet.

Continuation of therapy of the underlying disease, which led to the development of megaloblastic anemia.

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