1. MEGALOBLASTIC ANAEMIA
H.A. MWAKYOMA, MD

2. Megaloblastic Anemia Most common causes are Folate and B12 deficiency
B12 and folate are involved in the synthesis of thymidine
Impaired DNA synthesis causes a delay in mitotic division
Nucleus does not mature appropriately, cytoplasmic maturation proceeds normally

3. Megaloblastic Anemia Hypersegmented neutrophils

4. Megaloblastic Anemia Hypersegmented neutrophils

5. precursors
Increased MCV
Hypersegmented neutrophils
Decreased mature red cell production (absent reticulocyte response)
If severe white cell and platelet production can also be effected
Marked intramedullary red cell death

6. Folate Deficiency Present in fresh vegetables Body stores are small
Increased requirements
Pregnancy, hemolytic anemias, high cell turnover states
Decreased dietary intake
Malabsorption
Intestinal disease

7. B12 Deficiency Present in animal foods Body stores are large
Increased requirements
Decreased dietary intake
Malabsorption
In addition to hematologic abnormalities can be associated with neurologic symptoms

8. Pernicious Anemia B12 deficiency associated with atrophic gastritis
Associated with loss of gastric parietal cells, achlorhydria and deficient IF
Associated with antibodies to parietal cells and intrinsic factor

9. Objectives
Body stores and daily requirements of vitamin B12 and folate
Absorption of vitamin B12 and folate from the gut
Causes of vitamin B12 and folate deficiency
Hematological consequences of vitamin B12 and folate deficiency
Neurological sequelae of vitamin B12 deficiency
Diagnosis and management of megaloblastic anemia
Diagnosis and management of Pernicious Anemia

10. Requirements for Red Blood Cell Production
Erythropoeitin
Proteins, required for globin synthesis
Iron
Vitamin B12 and folic acid
Vitamin B6
Vitamin C
Thyroid hormones, estrogens and androgens

11. Vitamin B 12 and Folate

14. Macrocytic anemia with hypersegmented neutrophil

15. Macro-ovalocyte in megaloblastic anemia

16. Megaloblastic Anemia – Bone Marrow

17. Bone marrow - megaloblasts

24. Absorption and transport of vitamin B12

25. Absorption and transport of vitamin B12

33. Thank You