1. Megaloblastic Anemia Cytological and functional abnormalities in peripheral blood and bone marrow cells due to impaired DNA synthesis.

2. Megaloblastic Anemia The Megaloblastic anemia are caused by impaired DNA synthesis and almost always due to a deficiency of either B12 or Folate

3. ( Megaloblastic Anemia ( clinical features ‍The onset is usualy i nsidious and the patient have symptoms of anemia, have slight yellow tinge due to hemolysis Inceased ineffective erythropoisis.red and sore tongue,slight splenomegaly. In severe cases pancytopenia

4. Megaloblastic Anemia In Vit b12 deficiency, there may be neurological symptoms and other signs including optic atrophy, prepheral neuropathy, subacute combined degeneration of the cord and dementia

5. Megaloblastic Anemia Hematologic features Macrocytic anemia RBC Macro-ovalocytes Reticulocytosis Pancytopenia Hypersegmented poly Nucleuted RBC in PBS

11. Diagnosis of Mega a. due to Vit B12 deficiency : Schilling test :Loading dose of parenteral Vit B12 and then given oral radioactive B12 any absorbed B12 excreted in urine more then 10% over the next 24 hours The diagnosis of pernicious anemia is confirmed in the serum of autoantibodies to both parietal cells in over 90% and Intrinsic factor in over 50% of paients

12. Deffrentiating Cbl, Folate and combined deficiency. 1-Cobalamin deficiency: Serum Cobalamin and red blood cell Folate level are low. Serum folate level is normal. 2-Folate deficiency: Serum and red blood cell are normal. Serum cobalamin is normal. 3-Combined cobalamin and folat deficiency all three test results are low.

13. Serum Homocysteine and Methylmalonic acid levels - Reduced activity of methionin synthetase - Ellevated serum levels of Homocysteine. - Reduced conversion of MMCoA to succinyl CoA. - Elevated levels of Methyl Malonyl Co A.

14. Treatment of Megaloblastic anemia Hydroxycobalamin 5-10 ug/day im for two weeks A brisk reticulocye response after one week Followed by 1000 ug every three months Folate deficiency is treated with oral Folic acid 5 mg /day for 15 days then followed by 1mg/day Prophylactically in pregnancy,premature babies dialysis, and chronic hemolysis Folic acid should not given alone until B12 has been exc luded to prevent precipitate neurological changes

17. Treatment of Megaloblastic anemia Hydroxycobalamin 5-10 ug/day im for two weeks A brisk reticulocye response after one week Followed by 1000 ug every three months Folate deficiency is treated with oral Folic acid 5 mg /day for 15 days then followed by 1mg/day Prophylactically in pregnancy,premature babies dialysis, and chronic hemolysis Folic acid should not given alone until B12 has been exc luded to prevent precipitate neurological changes

18. Treatment of Megaloblastic anemia Hydroxycobalamin 5-10 ug/day im for two weeks A brisk reticulocye response after one week Followed by 1000 ug every three months Folate deficiency is treated with oral Folic acid 5 mg /day for 15 days then followed by 1mg/day Prophylactically in pregnancy,premature babies dialysis, and chronic hemolysis Folic acid should not given alone until B12 has been exc luded to prevent precipitate neurological changes

19. Treatment of Megaloblastic anemia Hydroxycobalamin 5-10 ug/day im for two weeks A brisk reticulocye response after one week Followed by 1000 ug every three months Folate deficiency is treated with oral Folic acid 5 mg /day for 15 days then followed by 1mg/day Prophylactically in pregnancy,premature babies dialysis, and chronic hemolysis Folic acid should not given alone until B12 has been exc luded to prevent precipitate neurological changes

21. Treatment of Megaloblastic anemia Hydroxycobalamin 5-10 ug/day im for two weeks A brisk reticulocye response after one week Followed by 1000 ug every three months Folate deficiency is treated with oral Folic acid 5 mg /day for 15 days then followed by 1mg/day Prophylactically in pregnancy,premature babies dialysis, and chronic hemolysis Folic acid should not given alone until B12 has been exc luded to prevent precipitate neurological changes

22. Treatment of Megaloblastic anemia Hydroxycobalamin 5-10 ug/day im for two weeks A brisk reticulocye response after one week Followed by 1000 ug every three months Folate deficiency is treated with oral Folic acid 5 mg /day for 15 days then followed by 1mg/day Prophylactically in pregnancy,premature babies dialysis, and chronic hemolysis Folic acid should not given alone until B12 has been exc luded to prevent precipitate neurological changes

23. Treatment of Megaloblastic anemia Hydroxycobalamin 5-10 ug/day im for two weeks A brisk reticulocye response after one week Followed by 1000 ug every three months Folate deficiency is treated with oral Folic acid 5 mg /day for 15 days then followed by 1mg/day Prophylactically in pregnancy,premature babies dialysis, and chronic hemolysis Folic acid should not given alone until B12 has been exc luded to prevent precipitate neurological changes

24. Treatment of Megaloblastic anemia Hydroxycobalamin 5-10 ug/day im for two weeks A brisk reticulocye response after one week Followed by 1000 ug every three months Folate deficiency is treated with oral Folic acid 5 mg /day for 15 days then followed by 1mg/day Prophylactically in pregnancy,premature babies dialysis, and chronic hemolysis Folic acid should not given alone until B12 has been exc luded to prevent precipitate neurological changes

26. Treatment of Megaloblastic anemia Hydroxycobalamin 5-10 ug/day im for two weeks A brisk reticulocye response after one week Followed by 1000 ug every three months Folate deficiency is treated with oral Folic acid 5 mg /day for 15 days then followed by 1mg/day Prophylactically in pregnancy,premature babies dialysis, and chronic hemolysis Folic acid should not given alone until B12 has been exc luded to prevent precipitate neurological changes