Macrocytic Anaemia

Macrocytic Anaemia

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Vitamin B12 Deficiency


Pathology:                   Essential for the synthesis of DNA, Vitamin B12 is required for the normal functioning of the body.


Aetiology:                    The deficiency of Vitamin B12 is caused by the lack of gastric intrinsic acid that binds the dietary B12 or due to the failure of the absorption in the terminal ileum, although dietary deficiency is much less common (body stores last for 2 -3 years).


Symptoms:                  The symptoms of Vitamin B12 deficiency include anemia, neuropathy, and bowel disease.


Signs:                              The signs of Vitamin B12 deficiency include pallor, congestive heart failure, peripheral neuropathy, confusion, and Sub-acute Combined Degeneration of the spinal cord.


Investigations:          Bloods: The investigations for Vitamin B12 deficiency include a full blood count (FBC), serum B12 and Folate.

Blood Film: The blood film reveals presence of oval macrocytes, and hypersegmented neutrophils.

Bone Marrow Biopsy: A bone marrow biopsy will help in checking the serum ferritin, lactate dehydrogenase (LDH), and homocysteine levels.


Treatment:                  The treatment for Vitamin B12 deficiency includes intramuscular hydroxocobalamin along with administration of folic acid.


Complications:          In cases of prolonged Vitamin B12 deficiency, neurological damage may be permanent, and may not be reversible even with timely treatment.


Prognosis:                    If treated in time, a symptomatic improvement may be seen within 24 hours. The overall prognosis is excellent if the treatment is timely and adequate.

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