Megaloblastic anemia
Release time : 04/25/2025 09:30:01
Megaloblastic anemia is a type of anemia, caused by a disorder in the synthesis of deoxyribonucleic acid (DNA), which is mainly due to a deficiency of Vitamin B12 or folic acid.
This disease is more common in northwest regions such as Shanxi and Shaanxi provinces, and commonly occurs in pregnant women and infants.
Macrocytic anemia is a severe condition that can cause significant harm to the human body. What are the causes of macrocytic anemia? How is it treated? Macrocytic anemia is a type of anemia caused by a deficiency in deoxyribonucleic acid (DNA) synthesis, primarily due to a lack of vitamin B12 or folic acid in the body. It can also be caused by genetic or acquired DNA synthesis disorders.
The characteristic feature of this disease is macrocytic anemia, with the appearance of megaloblastic series in the bone marrow, and morphological giant changes also observed in granulocytes and megakaryocytes series, even in certain proliferative somatic cells.
The macrocytic erythrocytes are easily destroyed in the bone marrow, resulting in an ineffective erythropoiesis.
In fact, megaloblastic anemia is not to be feared; it can be cured promptly if detected and treated in time.
Currently, some cases are mild and caused by dietary habits such as picky eating, refusal of food, improper cooking and malnutrition in infants. Change dietary habits, correct cooking methods and rational feeding of infants can be cured. In severe cases of cardiovascular complications, if not treated properly or not treated timely, it may cause death.
It is important to note that megaloblastic anemia can easily lead to the following complications: 1. Severe anemia can cause cardiac hypoxia and result in heart failure.
The activation of myocardial energy requires the assistance of VitB12, and if VitB12 is deficient, it can affect the activation of ATP and exacerbate the cardiac disorder, leading to the occurrence of heart failure.
Therefore, in patients with severe megaloblastic anemia, attention should be paid to the presence of cardiovascular diseases at the onset of treatment.
If such a thing happens, it is imperative to take the necessary measures in time to prevent any accidental incidents.
2. Bleeding.
Platelet deficiency and other coagulation factors are not uncommon in cases of megaloblastic anemia with bleeding, and sometimes cerebral hemorrhage or other types of hemorrhage may occur.
3. Gout.
Severe megaloblastic anemia may lead to increased lysis of blood cells due to ineffective hematopoiesis within the bone marrow, resulting in elevated serum uric acid levels and triggering gout attacks, though this is extremely rare.
4. Mental abnormality.
Severe megaloblastic anemia can not only lead to peripheral neuritis but also cause psychiatric abnormalities, such as agitation, depression, reticence, and even somnambulism.
This may be related to abnormalities in brain nerve tissue caused by a deficiency of vitamin B12.
The etiology of megaloblastic anemia is analyzed and understood differently in both Traditional Chinese Medicine (TCM) and Western Medicine.
Insufficient Diet in Traditional Chinese Medicine Etiology: The human body relies entirely on dietary intake for various nutrients. Insufficient intake or nutritional deficiencies may occur due to inadequate dietary quality, such as in cases of poverty where the diet is of poor quality.
The relative nutritional deficiency may be caused by an increased demand, such as in the case of diseases affecting pregnant women and infants.
Dietary Imbalance: The human body requires a variety of nutrients that must be obtained from a diverse diet. If one is prone to picky eating, vegetarianism, or selective eating, they may not be able to obtain the necessary range of nutrients from their diet. Over time, this can lead to the development of diseases.
Spleen and Stomach Deficiency: The spleen and stomach are the foundation of postnatal life. The spleen governs transportation and transformation, serving as the source of qi and blood production, and also regulates the flow of blood within the vessels.
The stomach is responsible for receiving and decomposing food, while the spleen and stomach, one being a solid organ and the other a hollow organ, work in harmony to complete the digestion and absorption of food. They serve as the pivotal point for the ascent of the clear and the descent of the turbid, together nourishing the five zang organs, six fu organs, and the limbs and bones with the essence of food and water. This is the fundamental basis for the sustenance of life.
Spleen and stomach deficiency results in disordered transportation and inability to accept and transform food, thus causing various diseases.
2. Western Medical Pathogenesis: Western medicine posits that megaloblastic anemia is primarily caused by a deficiency of folate or (and) vitamin B12.
Folic acid deficiency (1) Insufficient folate intake.
The daily requirement of folic acid is between 200 and 400g.
The body stores only enough folic acid for four months.
Inadequate fresh vegetables, overcooking or canning may cause folic acid loss.
Ethanol can interfere with the metabolism of folic acid, and individuals who abuse alcohol often suffer from folate deficiency in the small intestine (particularly the duodenum) due to inflammation, tumors, surgical removal, and tropical enteropathic diarrhea.
I need to increase folic acid.
The daily requirement for folic acid in pregnant women is 400-600 mg, and in children and adolescents with growth and development, as well as patients with chronic repeated hemolytic anemia, leukemia, tumors, hyperthyroidism, and long-term chronic renal failure treated with hemodialysis, the need for folic acid will increase; if it is not supplemented adequately, folate deficiency can occur.
(3) Effect of medication.
Methotrexate, trimethoprim, and pyrimethamine can inhibit the action of dihydrofolate reductase, thereby affecting the generation of tetrahydrofolate.
The mechanism by which phenytoin sodium and phenobarbital affect folic acid is unclear, but it may involve increased breakdown of folic acid or inhibition of DNA synthesis.
Approximately 67% of patients taking oral sulfasalazine experience inhibited absorption of folic acid in the intestines.
(4) Others. Please translate the above text into English.
Patients with congenital deficiency of 5,10-methylenetetrahydrofolate reductase are often diagnosed around the age of 10. Some patients in intensive care units (ICUs) may experience acute folate deficiency.
Vitamin B12 Deficiency (1) Reduced Intake.
The human body stores approximately 2-5 mg of vitamin B12, while the daily requirement is only 0.5-1 µg. Under normal conditions, 5-10 µg of vitamin B12 enters the intestinal tract daily through bile. The intrinsic factor secreted by the stomach wall is sufficient to facilitate the reabsorption of vitamin B12 from the bile.
Vitamin B12 deficiency usually develops after about 10 to 15 years of vegetarianism.
Vitamin B12 deficiency is a common problem in elderly patients and those with gastrectomy, because of the reduced secretion of hydrochloric acid. Vitamin B12 absorption from the bile occurs through a hepatic recirculation (enterohepatic circulation). As in vegetarians, these individuals may not show clinical evidence of vitamin B12 deficiency until 10-15 years later.
Therefore, megaloblastic anemia caused by insufficient intake of vitamin B12 is relatively rare due to dietary deficiency.
(2) Factor deficiency.
Primarily observed in patients with atrophic gastritis, after total gastrectomy, and in those with pernicious anemia.
At present, the mechanism of erythroblastosis is not clear.
Patients often have idiopathic gastric mucosal atrophy and anti- intrinsic factor antibodies. So it is suggested that the autoimmune disease of anemia may be one of the etiologies.
These patients have the deficiency of intrinsic factor and both absorption and reabsorption in bile are obstructed.
(3) Patients with severe pancreatic exocrine insufficiency are prone to poor absorption of vitamin B12.
It is because vitamin B12-R protein complex in the small intestine needs to be degraded by trypsin, so vitamin B12 can be released and combined with intrinsic factor.
Patients of this type typically exhibit clinical manifestations of vitamin B12 deficiency within 3 to 5 years.
Due to the fact that patients with chronic pancreatitis often promptly supplement trypsin, there are relatively few cases of vitamin B12 deficiency in clinical practice.
(4) Abnormally high concentrations of bacteria and parasites are present in the small intestine, which can also affect the absorption of Vitamin B12.
Because of these organic compounds, it is possible to ingest and retain vitamin B12 in large quantities.
Small intestinal diverticula or ulcers and the blind end of the small intestine often harbor bacteria that compete for vitamin B12 with human tissues, leading to vitamin B12 deficiency.
(5) Congenital transcobalamin II (TCII) deficiency and exposure to nitrous oxide (anesthesia) can also affect the plasma transport and cellular uptake of vitamin B12, leading to vitamin B12 deficiency.
What are the symptoms of megaloblastic anemia? What is the symptomatology of megaloblastic anemia divided into: general clinical symptoms and special type clinical symptoms.
1. General clinical symptoms: (1) Anemia - Patients with megaloblastic anemia generally present with symptoms of anemia.
Anemia is often insidious, and particularly in those with vitamin B 12 deficiency, it may take months.
Folic acid, due to its limited storage capacity in the body, can quickly lead to deficiency.
Patients who have contact with nitrous oxide, intensive care unit (ICU) or hemodialysis patients, as well as pregnant women, may experience deficiency in a short period of time. Clinically, it is generally manifested as moderate to severe anemia. In addition to symptoms like fatigue, dizziness, and shortness of breath upon exertion, severe cases may present with mild jaundice. Patients may also have leukopenia and thrombocytopenia, occasionally experiencing infections and increased bleeding tendency.
2. Gastrointestinal Symptoms: The gastrointestinal symptoms manifest as recurrent glossitis, smooth papillary projections on the tongue surface, and loss of taste sensation. There is a tendency towards loss of appetite, abdominal bloating, diarrhea, and constipation, with occasional occurrences.
3. Neurological symptoms? Vitamin B12 deficiency, especially in patients with pernicious anemia, often leads to neurological symptoms primarily due to damage to the posterior and lateral columns of the spinal cord and peripheral nerves.
They manifest as fatigue, symmetrical numbness of the hands and feet, sensory disturbances, and difficulty walking in a step.
In children and the elderly, mental abnormalities such as loss of consciousness, lack of desire, depression, drowsiness or delirium are commonly observed.
The neurological symptoms in patients with megaloblastic anemia may occur prior to the onset of anemia.
It is also important to note that the aforementioned three sets of symptoms can coexist in patients with megaloblastic anemia, or they may occur separately.
The severity of the condition can also be inconsistent when it occurs simultaneously.
2. Clinical Manifestations of Special Type: Tropical Enteritis-Diarrhea, also known as Tropical Nutritive Megaloblastic Anemia, has an unclear etiology.
It is commonly found among residents and tourists in tropical regions such as India, Southeast Asia, Central America, and the Middle East.
Clinical symptoms are similar to those of gluten-free enteropathy.
Serum folate and red blood cell folate levels are reduced. Folic acid therapy combined with broad-spectrum antibiotics can alleviate symptoms and correct anemia.
Upon remission, maintenance treatment with low-dose folic acid should be administered to prevent recurrence.
(2) Lactate Urine Syndrome Lactate urine syndrome is a genetically inherited disorder of purine metabolism, characterized by megaloblastic anemia and intellectual disability, as well as the presence of lactate crystals in the urine.
The serum folate or vitamin B12 concentrations were not low, and the treatment of folate or vitamin B12 was ineffective. Treatment with uracil could correct anemia.
(3) Malignant anemia is a macrocytic anemia caused by the gastric mucosal atrophy and the lack of intrinsic factor in gastric juice, so that vitamin B12 cannot be absorbed and it has similar pathogenesis to racial and genetic factors.
What data is required for the examination of megaloblastic anemia? 1. Blood morphology: Megaloblastic anemia (MCV > 100 fl) often presents with a decreased total blood cell count.
The number of neutrophils and platelets is reduced, but less than the degree of anemia.
In the blood smear, there are many large oval-shaped red cells, and the neutrophils have excessively lobulated nuclei, with up to five or six lobes.
Occasional presence of a large platelet network, and hematocrit is normal or mildly elevated.
2. Bone marrow examination reveals a proliferative bone marrow with significant red cell hyperplasia, and megaloblastic changes in all cell types, with the most pronounced changes observed in the red cells.
Red blood cells of all stages are larger than normal, the cytoplasm is more developed than nucleus (the nuclear development is imbalanced), and the nuclear chromatin is granular and concentrated.
Similar morphological changes can also be observed in the neutrophil and megakaryocyte series, with more pronounced changes seen in juvenile and rod-shaped nucleated cells.
Additionally, with relevant examinations conducted, how is megaloblastic anemia diagnosed in medicine? The diagnosis of megaloblastic anemia primarily relies on the combined characteristics of morphological blood cell features and clinical manifestations.
1. Etiology and clinical manifestations of folic acid and vitamin B12 deficiency.
Peripheral blood examination reveals macrocytic anemia (MCV > 100 fL), with the majority of red blood cells being large and oval in shape. Additionally, the nuclei of neutrophils exhibit excessive lobulation, with more than 5% of neutrophils having five-lobed nuclei or the presence of six-lobed nuclei.
3. There is a typical giant change in the bone marrow, with megaloblastic erythrocytes exceeding 10%, and also significant changes in the granulocytic and megakaryocytic systems.
No other abnormal hematologic findings.
4. Serum folate level is decreased to less than 6.81nmol/L, red blood cell folate level is less than 227nmol/L, vitamin B12 level is decreased to less than 75pmol/L.
Treatment of megaloblastic anemia: What should we do? In medicine, it is mainly divided into traditional Chinese medicine treatment and Western medicine treatment.
1. Traditional Chinese Medicine generally divides the treatment of this disease into three types: Qi and blood deficiency, Qi and spleen deficiency, and spleen and kidney deficiency. Treatment can be classified accordingly.
(1) Heart and spleen deficiency type: Treatment principle: strengthen the spleen, invigorate Qi, nourish blood, and calm the mind.
Prescription: The modified prescription is as follows: Astragalus, Codonopsis, Atractylodes, Roasted Jujube Seed, Angelica Sinensis, Longan Kernel, Rehmannia, White Peony Root, Schisandra Fruit, and Licorice.
The formula includes Astragalus, Codonopsis, Atractylodes, and Licorice, which are all warm and nutritious in nature, and have the effect of strengthening the spleen and benefiting Qi.
Danggui, white peony root, cooked rehmannia, longan meat, nourishing blood and yin.
Jujube seeds nourish the blood and calm the mind.
Schisandra chinensis, known as Wuweizi, is characterized by its sour and sweet flavors and the ability to transform Yin (or nourishing) properties.
For those with pronounced Yin deficiency and excessive fire, it is advisable to add Radix spatholobi, Radix Paeoniae Alba, and Radix rehmanniae to cool the blood and extinguish the fire.
Individuals with spleen deficiency and poor transportation, as well as symptoms of reduced appetite and loose stools, with significant abdominal distension, may benefit from the addition of Amomum villosum (Safflower), Citrus reticulata (Tangerine Peel), Aucklandia lappa (Aucklandia), and Trichosanthes kirilowii (Trichosanthes). This combination is designed to strengthen the spleen and regulate qi.
(2) Qi and blood deficiency type: Treatment principle: Supplement Qi and nourish blood.
Prescription: Eight-Zen Tang Modified Version Ingredients: Codonopsis, Atractylodes, Poria, Licorice Root, Angelica Sinensis, Rehmannia Root.
White Peony Root, Jujube, and Tangerine Peel.
The formula includes Radix Codonopsis, Atractylodes Macrocephalae, Poria Cocos, and Glycyrrhiza uralensis to enhance Qi and nourish the spleen.
Danggui, Rehmannia, and White Peony Radix are commonly used to nourish and replenish the blood.
Dates nourish the spleen, invigorate the blood, and harmonize the qi and wei.
If the blood deficiency is pronounced and presents with yin deficiency syndrome, add Rehmannia glutinosa and Lycium barbarum to nourish yin and generate blood.
For those with significant qi deficiency, it is advisable to add Astragalus.
If the skin's texture is significantly rough with noticeable itching, one may add Radix Paeoniae Rubra and Equisetum Abundans to cool the blood and activate blood circulation, and also use Fangfeng to dispel wind.
(3) Spleen and Kidney Deficiency Syndrome: Treatment Method: Invigorate the spleen and benefit the kidney.
Prescription: Modified Zhengzhong Decoction Ingredients: Dang Shen, Astragalus, Poria, Atractylodes, Rehmannia, White Peony Root, White Peony Root Bark, Ophiopogon, Cinnamon Bark, Aconite Seed, Cistanche, and Platycodon.
The formula includes Ginseng, Astragalus, Atractylodes, Poria, Licorice, Pinellia, and Ophiopogon to strengthen the spleen and nourish the middle, benefit the qi, generate blood.
Rehmannia glutinosa, Paeonia lactiflora, Cinnamomum cassia, Cistanche deserticola, and Aconitum carmichaelii are used to nourish the kidneys, strengthen vitality, and replenish essence and marrow.
For patients experiencing back pain and numbness in the lower limbs, it is advisable to add Chuanxiong (Chuanxiong) and Chicken Blood Tie (Jixueteng) to enhance blood circulation and unblock meridians.
For those with abdominal distension and loose stools, it is advisable to add Bupleurum and Evodia to supplement Yang and warm the middle burner.
Additionally, for the treatment of traditional Chinese medicine, Qigong therapy can also be chosen.
Qigong is a unique self-training method, which is a combination of medicine and sports for physical fitness.
It can exert human potential, through adjusting the body, mind, and breath, exercise the spirit of the essence, cultivate and strengthen true Qi, adjust the function of the organism, enhance physical strength, improve resistance to diseases, and achieve the purpose of treating diseases and strengthening the body.
2. Western medicine treatment: The first method involves general treatment of underlying diseases to eliminate the cause.
Enhance nutritional education to correct dietary preferences and poor cooking habits.
Second Type: Supplementation of Folic Acid or Vitamin B12 (1) Folate deficiency? Oral folic acid supplementation.
Gastrointestinal intolerance may be treated with intramuscular injection of calcium tetrahydrofolate until hemoglobin returns to normal.
Generally, no maintenance therapy is required.
2. Vitamin B12 deficiency? Intramuscular injection of vitamin B12 until the hemoglobin level returns to normal.
Malnutrition or gastrectomy patients need lifelong maintenance therapy, which is administered once every month.
Patients with vitamin B12 deficiency and neurological symptoms may have varying responses to treatment, sometimes requiring large doses and prolonged treatment (more than six months).
Patients with simple B12 deficiency should not be treated solely with folic acid, as this may exacerbate their B12 deficiency. Special attention should be paid to the potential occurrence or worsening of neurological symptoms.
(3) Patients with severe megaloblastic anemia should be vigilant for the occurrence of hypokalemia after treatment.
Due to the fact that during the recovery process of anemia, a large amount of potassium enters newly formed cells, there may suddenly be a low potassium level. Therefore, elderly patients and those with cardiovascular diseases and poor appetite should pay attention to timely supplementation of potassium salt.
The medical content mentioned in this text is for reference only.
In the event of discomfort, it is recommended to seek immediate medical attention for accurate diagnosis and treatment.