Megaloblastic Anemia

Question 1

How many years that vitamin B12 stores lasts?

Answer 1

3-5 years

Question 2

Source of vitamin B12?

Answer 2

Animal products

Question 3

Etiology of vitamin B12?

Answer 3

Strict vegan
Exclusive breastfeeding and maternal vegan diet
Removal of terminal ileum
IBD
Fish tapeworm
Absence of vitamin B12 transport protein and stomach IF

Question 4

Clinical presentation of vitamin B12 deficiency ?

Answer 4

Weakness
Fatigue
Failure to thrive
Irritability
Pallor
Glossitis
Vomiting
Diarrhea
Icterus
Neurological symptoms:
Paraesthesia
Development regression
Neuropsychiatric changes

Question 5

Laboratory findings?

Answer 5

Macrocytic anemia {MCV>100}
Megaloblastic changes including hyper-segmented neutrophils >5 lobes
Elevated LDH
Normal iron and folic acid level
Increased methylmalonic acid in urine
Increased homocysteine
Low reticulocytes count for degree of anemia
Anti parietal cell antibody positive in pernicious anemia
Less than 10% of cases present under age 40
Classic schilling test is no longer regarded as diagnostic test

Question 6

Treatment of vitamin B12?

Answer 6

Parenteral administration of vitamin B12 1mg daily
With neurological involvement continue for minimum of 2 weeks
Reticulocytosis in 2-4 days unless concurrent inflammatory disease
Maintenance of monthly IM vitamin B12

Question 7

Etiology of folic acid deficiency?

Answer 7

Nutritional - vegetable; fruits; animal organs such as liver and kidney
Inadequate intake - during pregnancy, growth in children and hemolytic anemia
Goat milk consumption
Decreased folic acid absorption - removal of ileum or IBD
Anticonvulsant medication such as phenytoin, primidone
Congenital dihydrofolate reductase deficiency
Drug induced abnormal metabolism- methotrexate

Question 8

Clinical presentation of folate deficiency?

Answer 8

Megaloblastic anemia
Irritability
Inadequate weight gain
Chronic diarrhea
Hemorrhage from thrombocytopenia in severe cases

Question 9

Laboratory findings of folate deficiency?

Answer 9

Macrocytic anemia MCV>100
Megaloblastic changes including hyper-segmented neutrophils >5 lobes
Elevated LDH
Hypercellular bone marrow

Question 10

Treatment of folate deficiency?

Answer 10

Rule out B12 deficiency before staring folic acid therapy
Folic acid 0.5 - 1mg/day IV or oral
Hematologist response can occur within 72 hr {diagnostic test as well}
Treatment continued for only 3-4 weeks
Maintenance dose is 0.2 mg daily