Macrocytic anemia
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| Macrocytic anemia | |
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| Megaloblastic anemia blood smear | |
| ICD-10 | D51.1, D52.0, D53.1 |
| ICD-9 | 281 |
| DiseasesDB | 29507 |
| MeSH | D000749 |
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Macrocytic anemia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Macrocytic anemia On the Web |
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American Roentgen Ray Society Images of Macrocytic anemia |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Macrocytic anemia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Analysis
The Schilling test was performed in the past to determine the nature of the vitamin B12 deficiency, but due to the lack of available radioactive B12, it is now largely a historical artifact. Vitamin BTemplate:Ssub is a necessary prosthetic group to the enzyme methylmalonyl-coenzyme A mutase. BTemplate:Ssub deficiency leads to dysfunction of this enzyme and a buildup of its substrate, methylmalonic acid, the elevated level of which can be detected in the urine and blood. Since the level of methylmalonic acid is not elevated in folic acid deficiency, this test provides a one tool in differentiating the two. However, since the test for elevated methylmalonic acid is not specific enough, the gold standard for the diagnosis of B12 deficiency is a low blood level of B12. Unlike the Shilling test, which often included B12 with intrinsic factor, a low level of blood B12 gives no indication as to the etiology of the low B12, which may result from a number of mechanisms.
Treatment
- 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.
el:Μακροκυτταρική αναιμία sq:Anemi makrocitike
References
gl:Anemia megaloblástica he:אנמיה מגלובלסטית it:Anemia megaloblastica sl:Megaloblastna anemija sr:Мегалобластна анемија