Megaloblastic (Pernicious) anemia is a type of anemia characterized by very large red blood cells. It is frequently due to lack of vitamin B12 and/or folic acid. Mild B-12 deficiency is common in older persons, most often resulting from achlorhydria. There are several causes of megaloblastic anemia. Certain diseases of the lower digestive tract can lead to megaloblastic anemia. These include celiac disease, chronic infectious enteritis, and enteroenteric fistulas. Certain hereditary disorders, drugs that affect DNA synthesis such as chemotherapy drugs, alcohol abuse, and other causes. Inherited congenital folate malabsorption, an inherited problem in which child’s cannot absorb folic acid in their intestines, can lead to megaloblastic anemia. Other causes of Megaloblastic Anemia are leukemia, myelofibrosis and multiple myeloma. The most frequent symptoms of megaloblastic anemia involve pale skin, lips, and hands, or pale under the eyelids, decreased appetite, irritability, lack of energy or tiring easily (fatigue), diarrhea, difficulty walking, numbness or tingling in hands and feet, smooth and tender tongue and weak muscles. The symptoms of megaloblastic anemia may be like other blood conditions or medical problems. Blood Transfusions are rarely required in patients with a megaloblastic anemia due to vitamin B-12 deficiency. Cobalamin therapy can be beneficial for patients with borderline cobalamin deficiency or in patients who present with only neuropsychiatric disorders. Treatment usually involves your child taking an oral dietary folic acid supplement for at least two to three months. Folate therapy is currently recommended for individuals with high levels of homocysteine who have a propensity for thromboembolic disease to prevent this complication. Multivitamins that contain folate have been recommended for elderly persons. Pernicious anemia is usually simply to treat with either vitamin shots (injections) or pills. People with pernicious anemia may get regular or weekly shots at first, then one shot every month. Some people get vitamin B12 shots and also take vitamin B12 pills. Many people with pernicious anemia can be treated successfully with vitamin B12 pills. Often, the pills work as well as the shots. Vitamin B12 can also be given in a gel or spray for the nose. Oral tablets are sometimes used. Tropical sprue should be treated with cobalamin and folate. Acute megaloblastic anemias due to nitrous oxide exposure can be treated with folate and cobalamin.
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