Megaloblastic anemia

Megaloblastic anemia is characterized by abnormal giant red blood cells regeneration that causes low quantity of erythrocytes.
Causes:
I. Vitamin B12 deficiency
1. Inadequate intake -- (a) Strict vegetarians (vegans). (b) Poor quality diet.
2. Malabsorption (a) Gastric -- Pernicious anaemia, congenital intrinsic factor deficiency, gastrectomy. (b)Intestinal -- Intestinal stagnant loop syndrome (e.g. jejunal diverticulosis, anatomical blind-loop, ileo-colic fistula), chronic tropical sprue, ileal resection and Crohn??s disease, selective malabsorption with proteinuria, fish tape-worm.
II. Folic and deficiency
1. Inadequate intake -- (a) Pool quality diet poverty, old age, alcoholism, goat??s milk. Kwashiorkor.
2. Malabsorption -- Gluten-induced enteropathy, dermatitis herpetiformis, tropical sprue, congenital folate malabsorption.
3. Increased cell turnover -- (a) Pregnancy and lactation. (b) Prematurity. (c) Chronic haemolytic anaemia. (d) Malignant disease. (e) Chronic inflammation (tuberculosis, rheumatoid arthritis).
4. Drugs -- Anticonvulsants, salazopyrin, trimethoprim. Alcohol.
5. Renal loss -- CCF, dialysis.
6. Metabolic -- Homocystinuria.
Clinical features
1. Due to anaemia -- Shortness of breath, dyspnoea, pallor and in older subjects angina or cardiac failure.
2. Gastrointestinal -- Diarrhoea, loss of appetite and weight. Sore tongue due to glossitis and angular cheilosis. Mild jaundice (from intramedullary breakdown of haemoglobin and shortened red cell life span) may give the patient a lemon yellow tint.
3. Neurological
(a) Vitamin B12 neuropathy -- due to symmetrical damage to peripheral ns. and posterior and lateral columns of sp. cord, the legs being more affected than arms. Psychiatric abnormalities and visual disturbances may occur (from folate deficiency).
(b) Neural tube defects -- Folic acid supplements during pregnancy have been show to reduce incidence of spina bifida, encephalocele and anencephaly in the fetus.
4. Gonadal dysfunction -- Deficiency of either B12 or folic acid may cause sterility, which is reversible with appropriate vitamin supplements.
5. Epithelial cell changes -- Glossitis and other epithelial surfaces may show cytological abnormalities.
6. CVS disease -- Raised serum homocysteine concentrations have been associated with arterial obstruction and venous thrombosis.
In traditional Chinese medicine studies, this disease belongs to the category of xu lao (weakness), it means the weakness of spleen and kidneys, insufficiency of blood essence. The formation of blood, its source came from the fluid metabolism, formation of blood also depends on blood essence, essence can form blood, therefore, the formation of blood is closely related to the kidney. The kidneys store the essence, regulate bones and growth of marrow which is connected with the brain system and serve as the root (basis) of our body system; if the kidneys are weak, there will be insufficiency of blood essence and marrow, thus lack of formation of blood. Therefore, the main aim of treatment is to strengthen the kidneys, then increases marrow and care for the spleen as well.