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__NOTOC__
'''For patient information click [[Megaloblastic anemia (patient information)|here]]'''
'''For patient information click [[Megaloblastic anemia (patient information)|here]]'''


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   Image          = Megaloblastic anemia.jpg |
   Image          = Megaloblastic anemia.jpg |
   Caption        = Megaloblastic anemia blood smear |
   Caption        = Megaloblastic anemia blood smear |
   DiseasesDB    = 29507 |
   DiseasesDB    = |
   ICD10          = {{ICD10|D|51|1|d|50}}, {{ICD10|D|52|0|d|50}}, {{ICD10|D|53|1|d|50}} |
   ICD10          = {{ICD10|D|51|1|d|50}}, {{ICD10|D|52|0|d|50}}, {{ICD10|D|53|1|d|50}} |
   ICD9          = {{ICD9|281}} |
   ICD9          = {{ICD9|281}} |
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{{Macrocytic anemia}}
{{Macrocytic anemia}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}} {{shyam}}; '''Associate Editor-In-Chief:''' {{OK}}, {{ADS}}, {{CZ}}


==[[Macrocytic anemia overview|Overview]]==
==[[Macrocytic anemia overview|Overview]]==
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==Diagnosis==
==Diagnosis==
==[[Macrocytic anemia history and symptoms|History and Symptoms]]==
[[Macrocytic anemia diagnostic study of choice|Diagnostic Study of Choice]] | [[Macrocytic anemia history and symptoms|History and Symptoms]] | [[Macrocytic anemia physical examination|Physical Examination]] | [[Macrocytic anemia laboratory findings|Laboratory Findings]] | [[Macrocytic anemia electrocardiogram|Electrocardiogram]] | [[Macrocytic anemia x-ray|X-ray]] | [[Macrocytic anemia echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Macrocytic anemia ct|CT]] | [[Macrocytic anemia mri|MRI]] | [[Macrocytic anemia other imaging findings|Other Imaging Findings]] | [[Macrocytic anemia other diagnostic studies|Other Diagnostic Studies]]
 
==[[Macrocytic anemia physical examination|Physical Examination]]==
 
==[[Macrocytic anemia laboratory findings|Laboratory Findings]]==
 
==[[Macrocytic anemia electrocardiogram|Electrocardiogram]]==
 
==[[Macrocytic anemia chest x ray|Chest X Ray]]==
 
==[[Macrocytic anemia CT|CT]]==
 
==[[Macrocytic anemia MRI|MRI]]==
 
==[[Macrocytic anemia echocardiography or ultrasound|Echocardiography or Ultrasound]]==
 
==[[Macrocytic anemia other imaging findings|Other Imaging Findings]]==
 
==[[Macrocytic anemia other diagnostic studies|Other Diagnostic Studies]]==
 
==Treatment==
==Treatment==
[[Macrocytic anemia medical therapy|Medical Therapy]] | [[Macrocytic anemia surgery|Surgery]] | [[Macrocytic anemia primary prevention|Primary Prevention]] | [[Macrocytic anemia secondary prevention|Secondary Prevention]] | [[Macrocytic anemia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Macrocytic anemia future or investigational therapies|Future or Investigational Therapies]]


==[[Macrocytic anemia medical therapy|Medical Therapy]]==
==Case Studies==
:[[Macrocytic anemia case study one|Case #1]]


==[[Macrocytic anemia surgery|Surgery]]==


==[[Macrocytic anemia primary prevention|Primary Prevention]]==


==[[Macrocytic anemia secondary prevention|Secondary Prevention]]==


==[[Macrocytic anemia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]]==
==[[Macrocytic anemia future or investigational therapies|Future or Investigational Therapies]]==
==Case Studies==


==[[Macrocytic anemia case study one|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 B{{ssub|12}} is a necessary prosthetic group to the enzyme [[methylmalonyl-coenzyme A mutase]].  B{{ssub|12}} 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]]
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==References==
{{Reflist|2}}
[[es:Anemia megaloblástica]]
[[gl:Anemia megaloblástica]]
[[he:אנמיה מגלובלסטית]]
[[it:Anemia megaloblastica]]
[[pl:Niedokrwistość megaloblastyczna]]
[[pt:Anemia megaloblástica]]
[[ru:Пернициозная анемия]]
[[sl:Megaloblastna anemija]]
[[sr:Мегалобластна анемија]]
[[tr:Megaloblastik anemi]]


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Latest revision as of 16:31, 2 December 2018

For patient information click here

Macrocytic anemia
Megaloblastic anemia blood smear
ICD-10 D51.1, D52.0, D53.1
ICD-9 281
MeSH D000749

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]; Associate Editor-In-Chief: Omer Kamal, M.D.[3], Amandeep Singh M.D.[4], Cafer Zorkun, M.D., Ph.D. [5]

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Macrocytic anemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-ray | Echocardiography and Ultrasound | CT | MRI | 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






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