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Megaloblastic Anemia

The megaloblastic anemias have in common certain abnormalities of red blood cells morphology and maturation


RBC are larger and shows asynchrony between maturation of nucleus and cytoplasm, with delay in nuclear progression chromatin in the nuclei of megaloblast is more open and immature as compared to the degree of maturity or haemoglobinization of the red blood cells.

LAB investigations

  1. Hb. 
  2. MCV >100
  3. Retic count low
  4. Neutrophils are large some with hyper segmented nuclei
  5. Level of iron normal / ↑
  6. Serum LDH ↑
  7. Bone marrow is hyper cellular because of erythroid hyperplasia.
  8. Level of serum folic acid and serum Vit B 12 is ↓ when it is due to their respective deficiency.
  9. Excessive excretion of methyl malonic acid in the urine is a reliable and sensitive index of vitamin B12 deficiency 

Juvenile Pernicious Anaemia

  1. This is rare A R disorder
  2. Results from an inability to secrete gastric intrinsic factor or secretion of a functionally abnormal IF, It differs from the typical disease in adult in that the stomach secretes acid normally and is histologically normal 

Clinical Manifestations

  1. 9 months - 11 year of age
  2. Weakness, irritability, anorexia, listlessness occur
  3. The tongue is smooth, red and painful
  4. Neurological Manifestations include ataxia, paresthesia, hyperreflexia Babinski response. Clonus and coma LAB  

Investigation - same

  1. In contrast to many adult cases with pernicious anemia serum antibodies directed against parietal cells or intrinsic factor cannot be detected in children with this disorder.
  2. Absorption of Vitamin B 12 is usually assessed by the schilling test

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