Macrocytic anemia medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

• Folate is administered 1mg QD. Higher doses may be required in malabsorptive syndromes. It is empirically given to those with SCD and those on HD.
• B12 must be given as a load then maintenance. Most advocate 1000 mcg IM Qweek x4 then 100mcg/month.
• [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 HCT will rise within 10days. If it does not, suspect another disorder. Hypersegmented PMNs disappear in 10-14 days.
• Neurologic abnormalities may take up to 6 months to resolve if ever. The longer the disease has been present, the worse is the prognosis for recovery.
• Persons with PA have a 2x risk of gastric CA (in some studies). Screen for occult blood.

Contraindicated medications

Macrocytic Anemia is considered an absolute contraindication to the use of the following medications:

• Sulfamethoxazole/Trimethoprim (oral)