Megaloblastic anemia

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2.

Objectives
• Body stores and daily requirements of vitamin B12
and folate
• Absorption of vitamin B12 and folate from the gut
• Causes of vitamin B12 and folate deficiency
• Hematological consequences of vitamin B12 and
folate deficiency
• Neurological sequelae of vitamin B12 deficiency
• Diagnosis and management of megaloblastic
anemia
• Diagnosis and management of Pernicious Anemia

3.

Requirements for Red Blood Cell
Production
Proteins, required for globin synthesis
Iron
Erythropoeitin
Vitamin B12 and folic acid
Vitamin B6
Vitamin C
Thyroid hormones, estrogens and androgens

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Vitamin B 12 and Folate

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Macrocytic anemia with hypersegmented neutrophil

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Macro-ovalocyte in megaloblastic anemia

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Macro-ovalocyte in megaloblastic anemia

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Megaloblastic Anemia – Bone Marrow

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Bone marrow - megaloblasts

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Important for DNA synthesis,
nervous tissue and fat metabolism
in the liver
an intermediate of the citric
acid cycle, porphyrin synthesis
(Heme synthesis)

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Absorption and
transport of
vitamin B12

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Absorption and
transport of
vitamin B12

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B12 /

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Pernicious Anemia (PA)
Early graying of
hair
Blue eyes

28.

Pernicious Anemia
Red beefy tongue

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Pernicious Anemia
Vitiligo

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PA
Normal
Gastric atrophy

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Atrophic Gastritis

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Clinical Manifestations of Vitamin B12 Deficiency
Hematologic
Megaloblastic anemia
Pancytopenia (leukopenia, thrombocytopenia)
Neurologic
Paresthesias
Peripheral neuropathy
Combined systems disease (demyelination of dorsal columns and corticospinal
tract)
Psychiatric
Irritability, personality change
Mild memory impairment, dementia
Depression
Psychosis
Cardiovascular
Possible increased risk of myocardial infarction and stroke

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The patient was a 45 year old woman. She had a swollen tender
tongue, parasthesias of both feet and hands, decreased
proprioception and vibratory sensation, ataxia and leg weakness.

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Subacute Combined Degeneration of Spinal Cord

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CBC:
Hb
Hct
MCV
MCH
RDW
WBC
Plt
106 g/l
32%
125 f
35.8 pg
14.9%
3.2
100
(120-160)
(35-46)
(80-100)
(27-33)
(9-15)
(4.8-10.8)
(150-400

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Retic
count