Megaloblastic Anemia Causes, Symptoms, How To Treat?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Megaloblastic anemia

Megaloblastic anemia is one of the types of anemias, characterized by disorders in the hematopoietic system in which erythrocytes with a low structure begin to form in the bone marrow. Also, megaloblastic anemia is called B12-deficiency anemia.

In the general structure of anemias, megaloblastic anemia occurs in 9-12% of cases. It develops with the same frequency in both men and women, but older people suffer from pathology more often.

Without treatment, megaloblastic anemia will progress and lead to serious health consequences.

Content:

• Causes of megaloblastic anemia
• Symptoms of megaloblastic anemia
• How to detect megaloblastic anemia?
• How to treat?
• Prevention and prognosis
• Which doctor treats megaloblastic anemia?

Causes of megaloblastic anemia

Megaloblastic anemia develops due to a lack of folic acid (vitamin B9) and vitamin B12 (cyanocobalamin) in the body.

The following factors can lead to a decrease in the level of vitamin B9:

• Errors in nutrition, when a person sharply restricts himself in food.
• Impaired absorption of vitamin B9 in the intestine. This occurs with various pathologies of the digestive tract, for example, enteritis, colitis, celiac disease.
• Postponed resection of the stomach or intestines.
• Certain periods in a person's life when the need for folic acid increases sharply, for example, the period of gestation and the period of breastfeeding.
• Some types of hemolytic anemias.
• Exfoliative dermatitis.
• Parasitic invasions, in particular, diphyllobothriasis.
• Conducting extrarenal blood cleansing.
• Liver pathologies: hepatitis and cirrhosis.
• Inflammation of the pancreas of a chronic course.
• Alcoholism.
• Taking certain medications: oral hormonal contraceptives, anticonvulsants, etc.

Vitamin B12 deficiency in the body can develop for the following reasons:

• Refusal of food of animal origin and adherence to vegetarianism.
• Cancer of the gastric wall or the presence of polyps in the stomach.
• Postponed resection of the stomach and small intestine.
• Adenoma of the pancreas is ulcerogenic.
• Carrying a baby and breastfeeding.
• Celiac disease.
• Crohn's disease.
• Liver pathologies: hepatitis and cirrhosis.
• Transcobalamin II deficiency.

Vitamin B12 and vitamin B9 are directly involved in the formation of human DNA and RNA, and the cells of the red bone marrow and mucous membranes of the digestive system will suffer first. It is they in the body that divide faster than others. In this pathology, erythrocyte precursor cells are not able to make a full transition to a more mature form. However, they do not die, their cytoplasm continues to grow and develop. As a result, large defective erythrocytes, which experts call megaloblasts, begin to circulate in the blood.

Vitamin B12 enters the body along with food. Its main source is animal products. In the stomach, it interacts with a special substance called gastromucoprotein. With it, vitamin B12 forms a complex compound and in such a bundle penetrates into the small intestine, where it is absorbed into the blood. Every day a healthy person should get 3 to 7 mcg of vitamin B12. In the liver, normally, it contains from 3 to 5 mg - this is a depot of cyanocobalamin. The body should receive more folic acid per day - about 100 mcg. Every day (with a standard diet), a person consumes from 300 to 750 mcg of folic acid. The body's depot contains about 5-10 mg of this substance.

Vitamin B12 contains 2 coenzymes. If there is a deficiency of the first coenzyme, then DNA is not able to form normally, which leads to a malfunction in the production of erythroid cells and the appearance of megaloblasts in the blood. The process of synthesis of leukocytes and platelets also suffers, but not to the same extent as erythrocytes.

In addition, the lack of the first coenzyme prevents the body from producing the amino acid (methionine), which is part of the myelin sheaths that cover the nerve trunks and cells. Therefore, the work of the nervous system as a whole is disrupted.

Deficiency of the second coenzyme, which is part of vitamin B12, leads to the fact that the metabolism of fatty acids is disrupted in the body. Toxins begin to accumulate in it, which affect the cells of the spinal cord. This pathology is called funicular myelosis.

Symptoms of megaloblastic anemia

Most often, megaloblastic anemia develops due to a lack of vitamin B12 in the body. All symptoms of this disorder are grouped into four large groups:

1. Symptoms associated with disturbances in the functioning of the digestive system. With megaloblastic anemia, atrophic changes occur in the mucous membranes of the stomach and intestines, and there is also a lack of production of enzymes necessary for normal digestion of food. This leads to the fact that patients present with the following complaints:

   • Lack of desire to eat.
   • Aversion to meat dishes.
   • Painful sensations in the region of the tongue, distortion of taste. The tongue may become bright in color, become covered with a shiny film (Gunther's atrophic glossitis).
   • Complaints of nausea, which can periodically end in vomiting.
   • Stool disorders (diarrhea).

2. Funicular myelosis symptoms.

   • Headaches.
   • Sensory disorders in the form of "crawling on the skin", skin tingling, etc.
   • Feeling of coldness in the limbs, deterioration of their sensitivity.
   • Changes in a person's gait.
   • Decreased muscle strength, and in severe anemia, the patient develops paralysis.

3. Circular hypoxic syndrome. Its manifestations:

   • Feeling of constant weakness.
   • Increased fatigue.
   • Shortness of breath. At first, it occurs against the background of physical activity, and then begins to disturb, even when the person is resting.
   • Heart palpitations.
   • Painful sensations in the chest (heart aches).
   • The skin becomes unnaturally pale, or even icteric.

4. Symptoms due to disturbances in the functioning of the nervous system:

   • A person's irritability increases, he becomes very nervous.
   • Hallucinations may occur.
   • Convulsions occur periodically.
   • Mental abilities deteriorate.

At the beginning of the development of anemia, a person may not present any complaints, since pathological symptoms during this period will be absent. There may be a slight deterioration in well-being, fatigue and mild dyspepsia. As a rule, during this period, patients do not go to doctors. Although already at this time, it is enough to do a blood test to detect developing anemia.

As the disease progresses, symptoms begin to gain strength. If a person already has any pathologies of the chronic course, then their clinic will be aggravated. For example, this is true for angina pectoris and arrhythmias. Also, swelling appears on the legs and arms, and also on the face.

In old age, anemia most often has a latent course. Patients do not indicate to the doctor that they are not feeling well, which makes diagnosis difficult.

How to detect megaloblastic anemia?

The search for the correct diagnosis begins with taking anamnesis and listening to the patient's complaints. An experienced doctor can already suspect anemia at this stage.

The patient examination includes the following steps:

• Examination of the skin: they are pale, sometimes with a yellowish tinge ("parchment skin").
• Tongue red and shiny, painful and slightly swollen.
• When listening to the heartbeat, systolic murmurs and tachycardia are diagnosed.
• During palpation of the peritoneum, an enlarged spleen is palpated.
• There are also signs of funicular myelosis.

The next stage of diagnosis is blood donation for clinical analysis. The results of the study will reveal a decrease in the number of erythrocytes and hemoglobin, the color index of blood exceeds 1.1. Sometimes anemia is accompanied by thrombopenia and leukopenia. Also, macrocytes and megaloblasts are visualized in the blood. Blood cells change their normal shape and size. Another sign of megaloblastic anemia is the presence of Kebbot's rings and Jolly's bodies in the blood. The reticulocyte count is low.

There is also a deficiency of folic acid and vitamin B12 in the serum. Serum iron levels remain within normal limits, or increase, which is caused by the accelerated destruction of red blood cells. This fact also provokes a jump in bilirubin in the blood.

The study of bone marrow, which is obtained by performing a sternal puncture, allows you to clarify the diagnosis. The study must be carried out in advance, that is, before starting treatment. The fact is that taking vitamin B12 in 1-2 days will return the bone marrow composition to normal, and the signs of megaloblastic anemia will be stopped.

The overwhelming majority of patients are diagnosed with damage to the mucous membranes of the digestive system with their atrophic changes. The production of hydrochloric acid in the stomach decreases.

Thus, the diagnosis of megaloblastic anemia consists of 3 main stages:

• Blood sampling for general analysis.
• Bone marrow puncture.
• Collecting anamnesis and studying the state of the organs of the digestive system, including the liver, spleen, etc.

It is imperative to exclude the fact that the patient has a parasitic invasion.

How to treat?

Treatment should be based on the underlying causes of the anemia. It may be necessary to take antiparasitic drugs, eliminate polyps or other neoplasms of the digestive system, treat intestinal diseases, place the patient in a drug treatment clinic if he suffers from alcohol dependence, etc.

It is imperative to adjust the patient's diet. It is necessary to add meat, liver, dairy products, fresh vegetables and fruits to its menu.

To eliminate vitamin B12 deficiency, intramuscular or intravenous administration of cyanocobalamin is possible. From 200 to 1000 μg of the drug can be prescribed per day, depending on the severity of the anemia.

After the blood counts return to normal, the dosage of the drug can be reduced, or the frequency of injections can be reduced. That is, the drug is administered once every 2 days, and then 2 times every 7 days.

Improvement occurs already a week after the start of treatment, which is characterized by the development of a reticulocytic crisis. In the blood, the level of young erythrocytes rises by 2-3%. The effectiveness of the therapy is indicated by the normalization of blood counts.

Sometimes vitamin B12 supplementation is prescribed for the rest of your life, for example, for Addison-Birmer anemia. With funicular myelosis, it is required to inject the patient daily from 800 to 100 mg of cyanocobalamin. It will be possible to reduce the dosage of the drug only after the patient is completely relieved of neurological symptoms.

Sometimes megaloblastic anemia is very difficult, and the patient himself may fall into a coma. In this case, he needs a red blood cell transfusion.

When autoimmune diseases are the main cause of anemia, the patient needs glucocorticosteroids. The dosage of the drug should be minimal, and the course of treatment should be short.

With folate deficiency anemia, folic acid is prescribed. The daily dose ranges from 1 to 5 mg of the drug, depending on the severity of the disease. After all the symptoms of anemia have been stopped, a course of folic acid will be required to prevent the recurrence of the disease. But the dose of the drug should be reduced.

Prevention and prognosis

To prevent the development of anemia, the following recommendations must be followed:

• Eat healthily by eating foods rich in vitamins B9 and B12.
• Lead a healthy lifestyle, give up alcoholism.
• Avoid situations that could lead to parasite infestation.
• Treat all diseases of the digestive system in time.

As for the prognosis, with timely therapy, it is favorable and it is possible to completely get rid of anemia.

Which doctor treats megaloblastic anemia?

When the first signs of anemia appear, you should contact your local physician. If the doctor detects such a violation, he will refer the patient to a hematologist who will prescribe treatment. It is possible to consult with narrow specialists, including: a neurologist, infectious disease specialist, hepatologist, gastroenterologist. You should visit a nutritionist to find an adequate diet.

The author of the article: Shutov Maxim Evgenievich | Hematologist

Education: In 2013 he graduated from the Kursk State Medical University and received a diploma "General Medicine". After 2 years, completed residency in the specialty "Oncology". In 2016 completed postgraduate studies at the National Medical and Surgical Center named after N. I. Pirogov.