Megaloblastic Anemia

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This  is  a  condition  whereby  the  bone  marrow  usually  produces  large,  structurally  abnormal,  immature red blood cells (megaloblasts) often due to inadequate intake or malabsorption of vitamin  B₁₂ or folate.  

Clinical presentation  

Pallor, depression, hair loss, pins and needles, numbness in hands or feet, tremors and palsies,  mildly jaundiced (lemon yellow tint), beefy tongue, darkening of palms and ataxic gait. 

Investigations 

• FBC-Low Hb, sometime pancytopenia, raised mcv but maybe low or normal if coexisting with iron deficiency (combined deficiency anaemia) 
• Peripheral smear 
• Serum vitamin B₁₂,  
• Serum folate level,  
• TSH 
• Reticulocyte count 
• Bone marrow aspiration may be indicated 

Pharmacological Treatment 

Vitamin (B₁₂ deficiency anaemia) and other macrocytic without neurological involvement.  

C: hydroxycobalamine (IM) initially 1mg 3times a week for 2weeks then 1mg (IM) every  3months.  

Review the patient’s blood counts and clinical assessment every 3months.   

Pernicious Anaemia (B₁₂ deficiency) with neurological symptoms and signs  

C:  hydroxycobalamine  (IM)  initially  1mg  on  alternate  days  until  no  further  improvement 

(maximum  reversal  or  neuro-psychiatric  signs  and  symptoms  are  achieved)  then  1mg  every 2-3months 

AND 

A: folic acid (PO) 5mg 24hourly for at least 3months this must be started simultaneously  with injection vitamin B₁₂ 

AND 

A: ferrous sulphate (PO) 200mg 8hourly for at least 3months.