MEGALOBLASTIC ANAEMIA H.A. MWAKYOMA, MD

Megaloblastic Anemia Most common causes are Folate and B12 deficiency B12 and folate are involved in the synthesis of thymidine Impaired DNA synthesis causes a delay in mitotic division Nucleus does not mature appropriately, cytoplasmic maturation proceeds normally

Megaloblastic Anemia Hypersegmented neutrophils

Megaloblastic Anemia Hypersegmented neutrophils

precursors Increased MCV Hypersegmented neutrophils Decreased mature red cell production (absent reticulocyte response) If severe white cell and platelet production can also be effected Marked intramedullary red cell death

Folate Deficiency Present in fresh vegetables Body stores are small Increased requirements Pregnancy, hemolytic anemias, high cell turnover states Decreased dietary intake Malabsorption Intestinal disease

B12 Deficiency Present in animal foods Body stores are large Increased requirements Decreased dietary intake Malabsorption In addition to hematologic abnormalities can be associated with neurologic symptoms

Pernicious Anemia B12 deficiency associated with atrophic gastritis Associated with loss of gastric parietal cells, achlorhydria and deficient IF Associated with antibodies to parietal cells and intrinsic factor

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

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

Vitamin B 12 and Folate

Macrocytic anemia with hypersegmented neutrophil

Macro-ovalocyte in megaloblastic anemia

Megaloblastic Anemia – Bone Marrow

Bone marrow - megaloblasts

Absorption and transport of vitamin B12

Absorption and transport of vitamin B12

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