NUTRITIONAL ANEMIA

MEGALOBLASTIC ANEMIA – an emerging GLOBAL PROBLEM and it’s noteworthy ELEVEN – TITBITS

1 Megaloblastic Anemia is better viewed as a multi-system disorder with ANEMIA, centrally featured by large Erythrocytes bigger than 100 fL in terms of MCV ( macro-ovalocytes ) as the classic picture.

2 Nutritional Deficiency of Vitamin B 12 ( COBALMIN) is FIVE TIMES commoner than FOLATE deficiency. However, deficiency of both can also cause Pancytopenia and Osteopenia / Osteoporosis.

3  Vit. B 12 Deficiency is a worldwide problem, with Breastfed babies of B-12 Deficient mothers being at highest risk. Pure Vegetarian diet and cooking are other contributing factors.

4  FOLATE deficiency is less common but both Deficiency States can co-exist.

5  RDA for Vit.B 12 is 0.2 to 1 mcg. and that of FOLATE is 25-200 mcg. The former is absorbed in the ILEUM and the latter in DUODENUM – JEJUNUM.

6  LAB. TESTING of Serum Vit. B12 and FOLATE has little value . Serum HOMOCYSTEINE is increased in both deficiency states but MMA ( Methyl Malonic Acid ) rises only in VIT B 12 deficiency.

7  In Megaloblastic Anemia, there is defective DNA SYNTHESIS leading to poor Nuclear maturation, vis-a-vis Cytoplasmic Maturation.

8 Haematological Findings are HyperSegmented Neutrophills ( six or more lobes) + Macro-Ovalocytes, Reticulocytes less than 1 % , Leukopenia and occasionally Thrombocytopenia .
Nucleated RBCs are seen in Per. Smear, if Hematocrit is less than 20 % ( Since all Cell lines are down, it could easily mimic Aplastic Anemia )
Bone Marrow shows reversed M/E RATIO and giant Metamyelocytes.

9.  NEUROLOGICAL SYMPTOMS can be either : Tremors, Hypotonia, Seizures, Parasthesias and Development Regression. However, Cognitive Dysfunction is likely to stay, despite therapy.

10  Skin changes are Hyperpigmentation of knuckles and terminal phalanges . ATP SYNDROME ( anemia+ tremor+ pigmentation TRIAD ) is a classic clinical pointer in children.

11  Treatment Priority is with B12 replacement and FOLATE supplementation comes after the former is managed. Parenteral Vitamin B 12 is better administered by IV injection , rather than IM route, in view of the likelihood of Thrombocytopenia and local bleeds.

Dr. Dhananjay Shah
Ped. Practice of 40 years
FELLOW IAP 2006
Crusader @ IAP
Worthy Candidate for IAP PRESIDENT ELECT 2022
Call: 9898003607
Call: 9825478060

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