1. MEGALOBLASTIC ANEMIA

2. Contents
Introduction
Causes
Symptoms
Diagnostic Test
Confirmatory Test
Treatment
Prevention
Case Study
Conclusion
References

3. Introduction
• Type of anemia.
• Produce very large size of red blood cell.
• Produce fewer cells.
• Oval in shape.

4. Causes
• Due to folate or cobalamin deficiency.
• Digestive disease.
• Malabsorption.
• Medication induced folic acid deficiency.

5. Symptoms
• Anemia
• Painful tingling of the hand and feet
• Decreased appetite
• Fatigue
• Weakness
• Irritability and status mental changes
• Weight loss

6. Diagnostic Test
• General finding from a medical history and
physical examination.
• Complete blood count.
• Barium study of digestive system.

7. Confirmatory Test
i. Schilling Test
• Two doses of Vitamin B12:
- small dose (radiolabeled) – orally
- larger dose (unlabeled) –
intramuscularly.
• 24 hours urine collection.

8. Cont…
ii. Bone marrow biopsy
• Deficiency of Vitamin B12 or folic acid
decreased DNA synthesis slows
nuclear maturation.
• Cytoplasmic maturation is advanced.

9. Cont…
Figure 1: The impaired nuclear maturation is
seen as open, loose, immature
chromatin.

10. Treatment
• Correct the condition.
• The underlying cause identified
adequate long term treatment.
• Vitamin B12 injections:
- Daily for 1 week
- Weekly for 4 weeks
- Monthly till levels are stabilized
• Oral Vitamin B12.

11. Prevention
• Restricted alcohol consumption.
• Adequate intake of food containing
Vitamin B12 and folic acid.

12. Case Study
A Breast-fed Newborn With
Megaloblastic Anemia-treated
With the Vitamin B12
Supplementation of the Mother

13. History
 A full-term female newborn weighing
2180g.
 Severe pallor and mild respiratory distress.
 Mother:
⁻ Second pregnancy
⁻ Vegan
⁻ No vitamin B12 supplementation
⁻ Intrauterine growth retardation.

14. Diagnostic Test
 Physical examination:
- Small for gestation age
- Pallor
- Mild tachypnea (65/min)
- Tachycardia (180/min)
- Cardiac murmur.

15. Cont…
 Neurological examination:
- Normal tonus and newborn reflexes.
 Laboratory diagnosis:
- Complete blood count: severe macrocytic
anemia
- Hemoglobin: 7.6 mg/dL (14-20 mg/dL)
- Hematocrit: 24.8% (42%-64%)
- Mean corpuscular volume: 125 fl (100-120 fl)
- Serum vitamin B12: 148 pg/mL (293-1208
pg/mL)
- Serum folic acid: 6.5 ng/mL (1.5-16.9 ng/mL).

16. Cont…
 Peripheral blood smear:
- Significant megaloblastic alteration

17. Cont…
- Nuclear-cytoplasmic asynchrony

18. Cont…
- Anisocytosis and poikilocytosis

19. Cont…
- Macrocytes

20. Cont…
- Stomatocytes

21. Cont…
- Target cells

22. Cont…
- Normoblasts with clover-leaf nuclei

23. Treatment
• Erythrocytes transfusion.
• Intramuscular injection of vitamin B12 at
1000µg/d for 10 days.
• Followed by 1000 mg 3 times per week for 2
weeks.
• Subsequently at 1000 mg per week for 4 weeks.
• After this regimen, the mother received 1000 mg
per month for 3 additional months.
• Newborn was fed exclusively with the breast milk.

24. Discharge Summary
• Vitamin B12 level progressively increased in
both individuals.
• No neurologic sequelae.
• No anemia.

25. Conclusion
• Megaloblastic anemia rare blood disorder
• Caused by defect in absorption or
inadequate intake of Vitamin B12 or folic acid
• Results low Vitamin B12 or folic acid in
blood produce abnormal enlarged red
blood cells.

26. References
• Omer Erdeve, MD, Saadet Arsan, MD,* Begum Atasay, MD,
Talia Ileri, MD, and Zumrut Uysal, MD. (2009). A Breast-fed Newborn
With Megaloblastic Anemia-treated With the Vitamin B12
Supplementation of the Mother. Pediatric Hematology Oncology.
31:763–765.
• HealthLineInfo. Megaloblastic Anemia. [Online] Available from:
http://healthlineinfo.com/megaloblastic-anemia-symptoms-
diagnosis-and-treatment.html
• The Health and Disease Blog. Schilling Test. [Online] Available from:
http://thehealthanddiseaseblog.blogspot.com/2011/10/schilling-test-
what-is-it-principle.html#gsc.tab=0
• FreeMD. Megaloblastic Anemia. [Online] Available from:
http://www.freemd.com/megaloblastic-anemia/prevention.htm