Megaloblastic anemia

Megaloblastic anemia is a group of diseases characterized by the presence of megaloblasts in the bone marrow and macro-cells in the peripheral blood.

In more than 95% of cases, megaloblastic anemia develops as a result of deficiency of folate and vitamin B ₁₂ or a congenital anomaly of their metabolism.

[1], [2], [3], [4], [5]

Causes of megaloblastic anemia

There are following reasons for the development of megaloblastic anemia.

Deficiency of vitamin B ₁₂ :

• alimentary deficiency (vitamin B ₁₂ <2 mg / day, vitamin B ₁₂ deficiency in the mother, leading to a decreased vitamin B ₁₂ content in breast milk).

What provokes megaloblastic anemia?

[6], [7], [8]

Pathogenesis

Megaloblastic anemia unites a group of acquired and hereditary anemias, a common feature of which is the presence of megaloblasts in the bone marrow.

Regardless of the cause, hyperchromic anemia with characteristic changes in the morphology of erythrocytes, erythrocytes of oval form, large (up to 1 2 - 1 4 microns and more) is revealed in patients. There are erythrocytes with basophilic cytoplasmatic location, in many of them the remains of the nucleus are found (Jolly's bodies are the remains of nuclear chromatin, the Keboat rings are the remains of the nuclear envelope that look like a ringlet, Weidenreich dust particles are the remains of nuclear matter).

Pathogenesis of megaloblastic anemia

Symptoms of lack of folate and cobalamin

Initial manifestations (can be observed for several months before the unfolded clinical picture):

• megaloblastic anemia;
• paresthesia;
• soreness of the tongue or of the entire oral cavity;
• red smooth ("lacquered") language;

Symptoms of megaloblastic anemia

Diagnosis of megaloblastic anemia

When collecting an anamnesis patient pay attention to:

• long-term use of antibiotics and anticonvulsants;
• type of diet / nutrition;
• the presence and duration of diarrhea;
• surgical interventions on the digestive tract.

Diagnosis of megaloblastic anemia

[9], [10], [11]

Treatment of megaloblastic anemias

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.

How are megaloblastic anemias treated?