The focus of most Megaloblastic anemia treatment
Most regimes focus on giving the patient folate or cobalamin.
Megaloblastic anemia has an increased size of the red blood cells because the substances required for nucleic acid production are not available.
By replenishing these two components, the anemia can be reversed.
The megaloblastic treatment strategies are established according to the duration and severity of anemia that develops.
Usually megaloblastic anemia develops gradually and does not necessarily require blood transfusion as the body adjusts to low levels of haemoglobin over time.
Causes of megaloblastic anemia
Megaloblastic anemia can be caused by either a folate deficiency or vitamin B12 deficiency:
1. Vitamin B12 deficiency ( eventually leads to folate deficiency)
• Achlorhydria: indiced malabsorption
• Deficient dietary intake
• Deficient intrinsic factor in pernicious anemia or gastrectomy
• Celiac disease
• Biological competition e.g Diphyllobothrium latum (fish tapeworm)
• Chronic pancreatitis
• Ileal bypass surgery or resection
2. Folate deficiency:
• Deficient dietary intake
• Increased body requirement: pregnancy, infants, and cirrhosis
• Intestinal and jejunal resection
• Deficient thiamine and factors (e.g., enzymes) responsible for folate metabolism.
3. Combined Deficiency: vitamin B12 & folate.
Cause of Megaloblastic anemia
Megaloblastic anemia is a disorder of the blood obvious by the manifestation of oversize red blood cells. Anemia is a disorder of the blood that results in the loss of red blood cells.
Red blood cells transfer oxygen throughout the body; without adequate amounts, organs and tissues suffer due to a lack of oxygen.
In the case of megaloblastic anemia, this disorder is caused by imperfect configuration of the red blood cell resulting in large numbers of immature and partly developed cells. These red blood cells do not function like healthy red blood cells and crowd out the healthy cells, causing anemia. Since these cells are immature, and have a reduced life expectancy.
For information regarding symptons and Megaloblastic Anemia Complications refer to this link.
Megaloblastic anemia treatment
Megaloblastic anemia is a type of anemia which occurs as a result of inhibition of DNA synthesis during red blood cell production. Continued cell growth without cell division causes the cells to develop an enlarged shape.
Treatment guideline for megaloblastic anemia treatment includes dietary therapy which supplementing vitamin B12 and folate in the diet or blood transfusion if the situation demands.
Transfusion therapy should in fact be restricted to patients with severe, uncompensated and life threatening type of megaloblastic anemia.
The treatment guidelines involve these:
• Cobalamin therapy
A parenteral dose of cobalamin (vitamin B12) should be given on a daily basis for duration of two weeks.
The recommended daily dose is 100-1000 µg although a dose of 1000 µg is too large and is required for only a few individuals only. Those individuals who show a more severe degree of neurological impairment should be treated with a more aggressive protocol. Cobalamin can also be administered through an roal dose. T
he recommended range is 1000-2000 µg although the doses and schedules can be varied according to individual requirement. The absorption of cobalamin can be varied in different individuals hence the oral dosages are monitored more strictly.
To avoid these abnormalities in oral cobalamin absorption, it is preferred to give cobalamin parenterally.
It may be a practical strategy to start with parenteral therapy then shift to oral cobalamin. Advantages offered by oral combalamin are that it is less expensive and better tolerated by those undergoing treatment.
In some conditions however like haemophilia, oral treatment is preferred to avoid the risks associated with intramuscular injections.
Serum potassium may fall severely during therapies for folate or cobalamin deficiencies and it should be closely monitored to avoid the risk of comlications. Potassium supplements may be required to avoid this problem
• Folate therapy
Oral administration of folate is also a treatment for megaloblastic anemia.
The recommended dosage is 3-5 mg.
However if there is difficulty in oral administration or compliance, then folate can also be administered parenterally. Folate should especially be administered prophylactically in pregnancy, lactation and shortly after birth.
It not only prevents symptoms of megaloblastic anemia from arising but also helps prevent neural tube effects. Fortification of food and folic acid supplements can have many health benefits.
However there are some opponents to this therapy as it may mask the early signs of anemia due to cobalamin deficiency and it may appear with more serious neurological signs.
Megaloblastic anemia treatment guidelines
It is not recommended to start taking folate supplements until cobalamin deficiency has been ruled out.
This is because administration of folate may correct the symptom of anemia and may have a positive effect on red blood cells but it will not reverse the neurological impairment of cobalamin.
This will allow the neurological complications to progress while the warning signs of anemia are masked. So if megaloblastic anemia is suspected, you should start treatment with both folate and cobalamin.
Checking response to megaloblastic anemia treatment
Although most patients start to feel better soon after the therapy is started, it is best to monitor if the therapy has been truly effective or not.
The elevated level of lactate dehydrogenase (LDH) and indirect bilirubin should drop if the therapy has been effective.
A prolonged increased level of LDH indicates that the therapy has not been effective.
Reticulocytosis( growth of new red blood cells) should be observed in 3-5 days and should reach a peak level in ten days.
The hyper-segmented neutrophils that are a characteristic feature of megaloblastic anemia will take over 10 to 14 days to return to normal.
The haemoglobin level should be tested every week and it should rise with at a rate of 1g/dL per week.
This rise can be used as a useful indicator to monitor response.
If no noticeable change is observed even after 2 months, other causes of anemia should be analyzed.
If megaloblastic anemia treatment does not work, you should suspect iron deficiency as well.
Further information regarding treatment can be found at this post