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Diagnosis of Megaloblastic Anemia

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1 Diagnosis of Megaloblastic Anemia

2 Diagnostic Tests Serum Cobalamine:
Uses ELISA assay Normal Range: 118 – 148 pmol/L Cobalamine Deficiency: < 74 pmol/L Serum methylmalonate and Homocysteine Schilling Test Test for urinary excretion Studies absorption of Cobalamin Schilling Test: Patient fasts over night. Radioactive cyanocobalamin given orally. 2 hours later an IM injection of cyanocobalamin of 1 mg is given. A 24 h urine specimen is collected for determination of radioactivity; low excretion shows malabsoption; the oral dose is then given again after 48 hours with IF. Results distinguish between gastric and intestinal causes of cobalamin malabsorption.

3 Diagnostic Tests Serum Folate Red Cell Folate: Uses ELISA
Normal range: 11 nmol/L to 82 nmol/L Can be elevated from severe cobalamin deficency Red Cell Folate: Valuable test for body folate stores. Less affected than serum assay by diet and traces of hemolysis. Normal adult conc.: micrograms/L Subnormal levels occur in patients with Megaloblastic Anemia due to folate deficiency but also in nearly 2/3 of patient with severe cobalamine deficiency.

4 Treatment of Megaloblastic Anemia

5 Treatment Establish if it is a folate or cobalamine deficiency.
In patients who are severely ill, it may be necessary to treat with both vitamins in large doses Transfusion is usually unnecessary and inadvisable.

6 Treatment of Cobalamine Deficiency
Hydroxocobalamine Six 1000 micrograms IM injections given at 3-7 day intervals should replenish body stores. For maintenance therapy 1000 micrograms IM injection every three months. Cyanocobalamin Large daily oral doses ( micrograms)

7 Treatment of Folate Deficiency
Folic Acid Oral doses of 5-15 mg daily. Continue therapy for 4 months Cobalamine Deficincy must be excluded before large doses are given, otherwise cobalamine neuropathy may develop Folinic Acid A stable form of fully reduced folate. Given orally or parenterally to overcome toxic effects of methotrexate or other DHF reductase inhibitors.

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