Diagnosis of Megaloblastic Anaemia and Treatment —

Megaloblastic Anaemia

• The megaloblastic anaemias are disorders caused by impaired synthesis of DNA.
• Due to slow cell division, the cells are large, called megaloblastic cells, with more RNA than DNA.
• There may also be ineffective erythropoiesis.
• Most megaloblastic anaemias are due to deficiency of cobalamin j vitamin B₁₂ and deficiency of folic acid.
• Normal range of cobalamin in blood is 300 – 900 pgj ml. Less than 200 pgjml gives rise to significant defi­ciency features.
• Normal serum concentration of folic acid ranges from 6 – 20 ngjml. Less than 4 ngjml is significant folate deficiency.

Types of megaloblastic anaemia’s —

• 1. Gastric achlorhydria
• 2. Inadequate intake especially in pure vegetarians
• 3. Pernicious anaemia
• 4. ‘Congenital absence of intrinsic factor
• 5. Tropical sprue
• 6. Regional enteritis
• 7. Non-tropical sprue
• 8. Drugs like colchicine, neomycin, methotrexate, azathioprine, pyrimethamine, triamterene di­uretic.
• 9. Alcoholics
• 10. Pregnancy
• 11. Malignancy
• 12. Hemodialysis
• 13. Dihydrofolate reductase deficiency.

Clinical features symptoms of megaloblastic anaemia —

• Weakness, giddiness, vertigo, palpitations, angina, anorexia, weight loss, diarrhoea, peripheral nerve disease, demyelination of posterior and lateral col­umns-numbness, paraesthesia, weakness, ataxias; sphincter disturbances, dementia, psychosis.
• Neurological disease may occur even with normal hematocrit and normal RBC indices.
• In pernicious anaemia, the above features are seen along with other diseases of similar immunologic ori­gin, like Grave’s disease, vitiligo, and hypothyroid­ism.
• Pernicious anaemia is more common in elderly and rare below 30 years.

Treatment of Magloblastic Anaemia —

• Intramuscular cyanocobalamin – 100 IJg j week for 8 wks followed by 1000 IJgm intramuscular every month.
• For practically whole life, 2 mg crystalline B₁₂ may be given orally daily.
• Reticulocytosis occurs 5 days after therapy and pa­tients improve within a week.
• For severe cases-blood transfusion, packed RBCs, exchange transfusions may be given.
• Folates and cobalamin both must be given because the neurologic manifestations may be aggravated by giving folate alone.
• Cobalamin and folate deficiency may present without anaemia with neurologic manifestations only.
• Folic acid 1 – 5 mgjday orally is given.
• The patient must be advised to take balanced diet.

This is the short description of magloblastic anaemia.