Severe Megaloblastic Anemia: Vitamin Deficiency and Other Causes
REVIEW CME MOC Daniel S. Socha, MD Sherwin I. DeSouza, MD Aron Flagg, MD Department of Laboratory Medicine, Department of Hematology and Medical Oncology, Department of Pediatric Hematology and Oncology, Robert J. Tomsich Pathology and Laboratory Taussig Cancer Institute, Cleveland Clinic Yale School of Medicine, New Haven, CT Medicine Institute, Cleveland Clinic Mikkael Sekeres, MD, MS Heesun J. Rogers, MD, PhD Department of Hematology and Medical Oncology and Department Department of Laboratory Medicine, Robert J. Tomsich Pathology and of Translational Hematology and Oncology Research, Taussig Laboratory Medicine Institute,Cleveland Clinic; Assistant Professor, Cancer Institute, Cleveland Clinic; Professor, Cleveland Clinic Lerner Cleveland Clinic Lerner College of Medicine of Case Western Reserve College of Medicine of Case Western Reserve, Cleveland, OH University, Cleveland, OH Severe megaloblastic anemia: Vitamin defi ciency and other causes ABSTRACT ot all megaloblastic anemias result N from vitamin defi ciency, but most do. De- Megaloblastic anemia causes macrocytic anemia from termining the underlying cause and initiating ineffective red blood cell production and intramedullary prompt treatment are critical, as prognosis and hemolysis. The most common causes are folate (vitamin management differ among the various condi- B9 ) defi ciency and cobalamin (vitamin B12) defi ciency. tions. Megaloblastic anemia can be diagnosed based on char- This article describes the pathobiology, acteristic morphologic and laboratory fi ndings. However, presentation, evaluation, and treatment of se- other benign and neoplastic diseases need to be con- vere megaloblastic anemia and its 2 most com- sidered, particularly in severe cases. Therapy involves mon causes: folate (vitamin B9) and cobalamin treating the underlying cause—eg, with vitamin supple- (vitamin B12) defi ciency, with 2 representative mentation in cases of defi ciency, or with discontinuation case studies.
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