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'''For the WikiDoc page for this topic, click [[Anemia of chronic disease|here]].'''
__NOTOC__
 
{{Macrocytic anemia}}
{{CMG}} {{AE}}{{OK}}
{{CMG}}{{AE}}{{OK}}
{{Anemia of chronic disease (patient information)}}


==Overview==
==Overview==


Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are many types of anemia.
In 60% of anemic patients, [[megaloblastic anemia]] affects 2-4% of population. Patients of all age groups may develop [[megaloblastic anemia]]. The incidence of [[megaloblastic anemia]] increases with age. [[Megaloblastic anemia]] commonly affects older age group. Males are more commonly affected by [[megaloblastic anemia]] than females. In deficiencies of [[Vitamin B12|vitamin b12]] and [[folate]] causing [[megaloblastic anemia]], supplementation are made with [[Cyanocobalamine]] and [[Folic Acid]] respectively based on the severity and the cause. [[LDH]] falls in 2 days. [[Hypokalemia]] requiring replacement can occur in the acute phase as new cells are being generated rapidly. A [[reticulocytosis]] begins in 3-5 days and peaks in 10 days. The [[Hematocrit]] will rise within 10days. If it does not, suspect another disorder. Hypersegmented [[polymorphonuclear cells]] disappear in 10-14 days.
 
Anemia of chronic disease is anemia that is found in people with certain long-term (chronic) medical conditions.


==What are the symptoms of Macrocytic Anemia?==
==What are the symptoms of Macrocytic Anemia?==


Anemia of chronic disease is often mild. You may not notice symptoms of anemia.
[[Macrocytosis]] is a common feature of [[MDS]], especially in older adults. Patients with [[B12 deficiency]] show neurologic dysfunction, [[anemia]] symptoms such as [[fatigue]], [[dyspnea]], [[lightheadedness]], and [[anorexia]], [[high output cardiac failure]], [[angina]], [[diarrhea]], [[cheilosis]], [[glossitis]], [[Subacute combined degeneration of spinal cord|subacute combined degeneration]], broad based [[gait]], [[ataxia]], [[numbness]] or [[paresthesias]], Rhomberg and Babinski’s sign. [[Dementia]] may progress to frank “Megaloblastic Madness”:. Also may include:
 
If they occur, smptoms may include:


*Feeling weak or tired
*Feeling weak or tired
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==What causes Macrocytic Anemia?==
==What causes Macrocytic Anemia?==
 
* [[Vitamin B12 deficiency|Vitamin B12 Deficiency]]:  
Anemia is a lower-than-normal number of red blood cells in the blood. Certain chronic infections, inflammatory diseases, and other illnesses can affect the body's ability to produce red blood cells.
*# Deficient intake
 
*# Deficient intrinsic factor ([[pernicious anaemia]] or [[gastrectomy]])
Conditions that can lead to anemia of chronic disease include:
*# Bilogical competition for B12 by [[diverticulosis]], [[fistula]], intestinal [[anastomosis]], [[achlorhydria]] and infection by the marine parasite ''[[Diphyllobothrium latum]]''
 
*# Selective [[B12]] [[malabsorption]] (congenital and drug-induced)
*Autoimmune disorders, such as [[Crohn's disease]], [[systemic lupus erythematosus]], [[rheumatoid arthritis]], and [[ulcerative colitis]]
*# Chronic [[pancreatitis]]
*[[Cancer]], including [[lymphoma]] and [[Hodgkin's disease]]
*# Ileal resection and bypass
*[[Chronic kidney disease]]
* [[Folate]] Deficiency:
*Liver [[cirrhosis]]
*# Deficient intake
*Long-term infections, such as [[bacterial endocarditis]], [[osteomyelitis]] (bone infection), [[HIV]]/[[AIDS]], [[hepatitis B]] or [[hepatitis C]]
*# [[Alcoholism]]
*# Increased needs: [[pregnancy]], [[infant]], rapid cellular proliferation, and [[cirrhosis]]
*# Malabsorption (congenital and drug-induced)
*# [[Intestinal]] and jejunal resection


==Who is at highest risk?==
==Who is at highest risk?==
Risk factors for anemia of chronic disease include [[autoimmune disorders]], chronic infection, [[trauma]], major [[surgery]], [[malignancy]], [[HIV]] infection, rheumatologic disorders, [[inflammatory bowel disease]], [[castleman disease]], [[heart failure]], older adults, [[renal insufficiency]] and [[chronic obstructive pulmonary disease]].
Common risk factors of [[megaloblastic anemia]]:
* [[Folate deficiency]]
** Nutritionally deficient - Elderly, [[alcohol]], [[narcotic]] abuse
** Those with increased demand: [[pregnancy]], [[infancy]], low grade [[hemolysis]], [[malignancy]] or chronic [[hemodialysis]].
* Autoimmune disease such as [[Hashimoto's thyroiditis|Hashimoto’s]], [[vitiligo]], [[diabetes]], [[adrenal insufficiency]]. (Schmitt’s Syndrome).
* Strict vegans and/or their infant
* Malabsorptive disorders such as blind loops/[[Small intestinal bacterial overgrowth syndrome|bacterial overgrowth]], [[sprue]], whipple’s and [[Crohn's disease|crohn’s]] can malabsorb [[folate]] and [[B12]].
* D.Latum is a competitor for [[B12]] absorption. This entity is most commonly found in Scandinavia.


==Diagnosis==
==Diagnosis==
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==Treatment options==
==Treatment options==


[[Anemia]] is often mild enough that it does not need treatment. It will likely get better when the disease that is causing it is treated.
In deficiencies of [[Vitamin B12|vitamin b12]] and [[folate]] causing [[megaloblastic anemia]], supplementation are made with [[Cyanocobalamine]] and [[Folic Acid]] respectively based on the severity and the cause. [[LDH]] falls in 2 days. [[Hypokalemia]] requiring replacement can occur in the acute phase as new cells are being generated rapidly. A [[reticulocytosis]] begins in 3-5 days and peaks in 10 days. The [[Hematocrit]] will rise within 10days. If it does not, suspect another disorder. Hypersegmented [[polymorphonuclear cells]] disappear in 10-14 days.
 
The condition is rarely severe enough to need a [[blood transfusion]].
 
Iron supplements may sometimes be used, but only for patients whose [[iron]] levels are low. Taking iron pills when your body does not need it can lead to serious medical problems. Always talk with your health care provider first.
 
For some conditions, such as chronic kidney disease, medicine called [[erythropoietin]] may be given. It stimulates your [[bone marrow]] to make more red blood cells.


==Where to find medical care for Macrocytic Anemia?==
==Where to find medical care for Macrocytic Anemia?==
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==Prevention of Macrocytic Anemia==
==Prevention of Macrocytic Anemia==
There are no established measures for the prevention of [[anemia of chronic disease]].
Green leafy vegetables and meat are a good source of [[Vitamin B12|Vitamin B-12]]. [[Alcohol]] consumption can lead to [[macrocytic anemia]]. These are some of the primary ways to reduce the incidence of [[macrocytic anemia]].


==What to expect (Outlook/Prognosis)?==
==What to expect (Outlook/Prognosis)?==

Latest revision as of 01:35, 7 November 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2]

Overview

In 60% of anemic patients, megaloblastic anemia affects 2-4% of population. Patients of all age groups may develop megaloblastic anemia. The incidence of megaloblastic anemia increases with age. Megaloblastic anemia commonly affects older age group. Males are more commonly affected by megaloblastic anemia than females. In deficiencies of vitamin b12 and folate causing megaloblastic anemia, supplementation are made with Cyanocobalamine and Folic Acid respectively based on the severity and the cause. LDH falls in 2 days. Hypokalemia requiring replacement can occur in the acute phase as new cells are being generated rapidly. A reticulocytosis begins in 3-5 days and peaks in 10 days. The Hematocrit will rise within 10days. If it does not, suspect another disorder. Hypersegmented polymorphonuclear cells disappear in 10-14 days.

What are the symptoms of Macrocytic Anemia?

Macrocytosis is a common feature of MDS, especially in older adults. Patients with B12 deficiency show neurologic dysfunction, anemia symptoms such as fatigue, dyspnea, lightheadedness, and anorexia, high output cardiac failure, angina, diarrhea, cheilosis, glossitis, subacute combined degeneration, broad based gait, ataxia, numbness or paresthesias, Rhomberg and Babinski’s sign. Dementia may progress to frank “Megaloblastic Madness”:. Also may include:

What causes Macrocytic Anemia?

Who is at highest risk?

Common risk factors of megaloblastic anemia:

Diagnosis

The doctor will perform a physical examination.

Because anemia may be the first symptom of a serious illness, determining its cause is very important.

Tests that may be done to diagnose anemia or rule out other causes include:

When to seek urgent medical care?

Call for an appointment with your health care provider if you have a chronic disorder and you develop symptoms of anemia.

Treatment options

In deficiencies of vitamin b12 and folate causing megaloblastic anemia, supplementation are made with Cyanocobalamine and Folic Acid respectively based on the severity and the cause. LDH falls in 2 days. Hypokalemia requiring replacement can occur in the acute phase as new cells are being generated rapidly. A reticulocytosis begins in 3-5 days and peaks in 10 days. The Hematocrit will rise within 10days. If it does not, suspect another disorder. Hypersegmented polymorphonuclear cells disappear in 10-14 days.

Where to find medical care for Macrocytic Anemia?

Call for an appointment with your health care provider if you have a chronic disorder and you develop symptoms of anemia.

Prevention of Macrocytic Anemia

Green leafy vegetables and meat are a good source of Vitamin B-12. Alcohol consumption can lead to macrocytic anemia. These are some of the primary ways to reduce the incidence of macrocytic anemia.

What to expect (Outlook/Prognosis)?

The anemia will improve when the disease that is causing it is successfully treated.

Possible complications

Discomfort from symptoms is the main complication in most cases. Anemia may lead to a higher risk of death in patients with heart failure.

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000565.htm