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Megaloblastic Anemia

yunus — Tue, 02 Mar 2010 06:40:53 +0000

The cells require oxygen to function properly. Those responsible for carrying oxygen to the tissues are red cells, also called erythrocytes or RBCs. In the formation of DNA synthesis of the precursor cells of erythrocytes involving both vitamin B12 (cobalmina) and folic acid. If any of these items are missing is a decline in the rate of synthesis of cell DNA, a fact which implies that the red cell precursors increase in size. Furthermore, this alteration in cell maturation can occur makes their destruction, which contributes to anemia.

Thus, erythrocytes come in smaller numbers to the blood and changed in size because of this lack of vitamin B12 or folic acid, resulting in what is known as megaloblastic anemia.
How to produce

Lack of folic acid is the most common cause of megaloblastic anemia. Folic acid is obtained from the diet, from foods like meat, legumes, nuts or vegetables, and is absorbed in the jejunum. It is transported to the bone marrow to intervene in DNA synthesis of red blood cells and collects in deposits in the liver.

The main cause of lack of folic acid is its deficit in the diet, mainly from malnutrition and alcoholism, but may also be due to alterations in the uptake and storage caused by various intestinal and liver diseases, situations that increase their consumption as pregnancy or certain tumors, or certain drugs such as methotrexate, trimethoprim or triamterene.

Vitamin B12 is absorbed in the small intestine after joining in the stomach to a protein called intrinsic factor. Into the blood and transported together with another protein called transcobalamin that leads to bone marrow to intervene in the formation of red blood cells. The portion that is not used is stored in the liver.

Lack of vitamin B12 may be due to a shortage of it in the diet, poor intake of animal products, or a defect in intestinal absorption due to lack of intrinsic factor, alterations in their receptors, alterations of the mucosa intestinal, pancreatic disease or intestinal infections. It can also be caused by misuse of vitamin B12 or by an increased requirement of the same, as in pregnancy, tumors, hyperthyroidism or certain drugs.

Anyway, the most common cause of vitamin B12 deficiency is chronic atrophic gastritis, ie longstanding atrophy of the stomach lining that prevents the vitamin. The atrophy may be due to an autoimmune disease called pernicious anemia, in which the body makes antibodies against the mucosal cells, which prevents the formation of intrinsic factor and thus the absorption of vitamin B12. Furthermore, by a mucosal atrophy, fewer gastric juices, which also hampers the absorption of iron, a fact which can aggravate anemia.
Symptoms

The symptoms of megaloblastic anemia are the classics of anemia, namely, pale skin and mucous membranes, fatigue, dyspnea, palpitations, headache, poor concentration, irritability, insomnia, decreased libido, effects of poor oxygenation tissues. In general, gradually introducing megaloblastic anemia, which these symptoms are generally well tolerated.

When megaloblastic anemia is caused by a vitamin B12 deficiency, other symptoms related to the participation of this substance in the formation of myelin that covers nerves. This implies that demyelinating polyneuropathy may occur as well as involvement at the level of the spinal cord, which results in impairment of vibratory sensation and proprioception (the position to recognize the different parts of the body), which is known as combined degeneration subacute spinal cord. Eventually you can reach a state of dementia. The degree of neurological involvement does not depend on the severity of anemia.

Other alterations that can accompany megaloblastic anemia due to vitamin B12 deficiency are atrophy of the tongue, intestinal malabsorption, blue sclera or vitiligo.

Diagnosis

Diagnosis is based on the interrogation of the patient and analytical data. It should detect symptoms of fatigue, pallor, dyspnea, headache or other neurological disorders, especially in case of suspicion of a vitamin B12 deficiency. Also be used to evaluate the diet that bears the patient and his bowel movements.

Suspecting anemia perform a complete blood test, which should include blood count and basic biochemistry, as well as vitamin B12 and folic acid.

In the analytical appreciate Megaloblastic anemia is a decrease of normal hemoglobin levels. Typically the red cells of megaloblastic anemia are larger and contain more hemoglobin, and this is titrated with specific parameters, which are the mean corpuscular volume (MCV), which assesses the average size of erythrocytes and mean corpuscular hemoglobin (HCM), which measures the average amount of hemoglobin per erythrocyte. Since there is an increase in both the MCV and the MCH, megaloblastic anemia is classified as a macrocytic anemia (larger cells) and hyperchromatic (greater amount of hemoglobin).

Also assessed in blood reticulocytes, ie, young forms of erythrocytes present in blood, which in this case will be elevated. Another characteristic finding a kind of neutrophils and an increase of an enzyme called lactate dehydrogenase (LDH) due to the destruction of erythrocytes occurs.

Levels of vitamin B12 or folic acid can be determined in plasma and they will be reduced if the cause of megaloblastic anemia.

In cases of suspected pernicious anemia blood sought in intrinsic factor antibodies, which are positive in 2 of 3 patients with pernicious anemia, and if there is doubt perform a test called the Schilling test, which allows management by radiolabelled vitamin B12 and intrinsic factor in assessing whether the cause is really a pernicious anemia.

The confirmation test would give megaloblastic anemia bone marrow biopsy but this test is not performed rarely because laboratory findings can accurately diagnose this type of anemia.

Treatment

The treatment will consist of two approaches: first remedy the lack of vitamin B12 or folic acid in the patient and the other address, if possible, cause it originates.

In case of megaloblastic anemia due to lack of vitamin B12 intake should reinforce the patient’s diet to make them have an adequate intake of this vitamin and supplement if necessary with vitamin B12 orally. In more serious cases will be administered intramuscularly. If the cause of megaloblastic anemia is pernicious anemia, should be administered for life. The treatment is accompanied by the administration of folic acid. In the case of pernicious anemia is digestive track patient because of chronic gastritis may eventually develop into a carcinoma of the stomach.

In case you megaloblastic anemia caused by a deficiency of folic acid administered it orally for four months.

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Symptoms of Anemia

West baby — Tue, 22 Dec 2009 09:16:00 +0000

Anemia affects you if your blood does not have quite enough hemoglobin or red blood cells. Since the early symptoms of anemia, is soft, it’s easy to confuse the symptoms of anemia from symptoms of some serious disease. The anemia could have an adverse impact on quality of life. The major symptoms of anemia include: heart palpitation, fatigue, dizziness, loss of concentration, rapid breathing, heart and pale skin. The lack of morale and depression could also be an important symptom of anemia.

The pulse of headache, irritability, syncope and limitation is also symptoms of anemia. The observable signs of anemia include tachycardia, mild peripheral edema, ejection systolic murmur and venous snoring. The angina pectoris among old people is a clear sign of anemia. Females tend to develop abnormal menstruation and amenorrhea if anemia affects while men develop impotence and decrease in libido. The anemia could either be the result of an inherited disorder or may be due to their environment, such as infection or exposure to a toxin or drug.

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What is Anemia and What Causes Anemia?

Mariah Carey — Thu, 01 Oct 2009 10:45:51 +0000

Anemia occurs when blood does not have enough red blood cells or when the blood does not have enough hemoglobin. Hemoglobin is the oxygen-carrying pigment found in red blood cells. Anemia can be life-threatening. It is a condition that develops when your blood lacks enough healthy red blood cells. These cells are the main transporters of oxygen to organs.

If red blood cells are also deficient in hemoglobin, then your body isn’t getting enough iron. Anemia occurs when your blood doesn’t have enough hemoglobin. Hemoglobin is a protein in your red blood cells that carries oxygen from your lungs to the rest of your body.

A common cause of anemia is not having enough iron. Blood is actually a liquid made up of several different cell types. One of the most important and most numerous cell types is the red blood cell. The purpose of the red blood cell is to deliver oxygen to the body. Anemia describes the condition in which the number of red blood cells in your blood is low. For this reason, doctors sometimes describe someone with anemia as having a low blood count. A person who has anemia is called anemic.

RBCs are disc-shaped and look like doughnuts without a hole in the center. They are produced continually in the spongy marrow inside the large bones of the body and normally last 120 days. RBC main role is to carry oxygen, but they also remove carbon dioxide (a waste product) from cells and carry it to the lungs to be exhaled. White blood cells and platelets are the two other kinds of blood cells. White blood cells help fight infections.

What causes anemia?
The individual causes of anemia are numerous, but most can be grouped within three major mechanisms that produce anemia: blood loss (excessive bleeding), inadequate production of red blood cells, or excessive destruction of red blood cells. Anemia may be caused by excessive bleeding. Bleeding may be sudden, as may occur in an accident or during surgery. Often, bleeding is gradual and repetitive, typically from abnormalities in the digestive or urinary tract.

Blood loss: excessive bleeding such as hemorrhages or abnormal menstrual bleeding

Chronic illness secondary to refractory anemia: inflammatory GI/GU diseases, malignancies (cancer), arthritis, kidney or liver failure, and acute and chronic infections

Cancer therapy: surgery, radiotherapy, chemotherapy and/or immunotherapy

Infiltration (replacement) of bone marrow with cancer

Hemolysis: Breakdown or destruction of red blood cells

Decreased red cell production due to low levels of erythropoietin

Higher than normal rates of RBC destruction can be the result of inherited blood disorders like sickle cell anemia, and certain enzyme deficiencies. These disorders create abnormalities in the RBCs that cause them to die off in a shorter period of time than healthy RBCs. In people with hemolytic anemia, the immune system mistakenly attacks RBCs.

Decreased red cell production by the bone marrow
Pregnant women are at an increased risk of iron deficiency anemia because their iron stores have to serve the increased blood volume of the mother as well as be a source of hemoglobin for the growing fetus.