PowerPoint Presentation: " MEGALOBLASTIC ANEMIA " Made by!! DR MADEEHA KHAN PowerPoint Presentation: " MEGALOBLASTIC ANEMIA" Megaloblastic (Macrocystic) anemia is a blood disorder in which there is anemia with larger-than-normal red blood cells. is a condition in which body can't make enough healthy red blood cells because of vitamin B12 and folic acid deficiency. Also knowns as “pernicious anemia” means “deadly.” The condition is called pernicious anemia because it was fatal in the past, before vitamin B12 treatments were available. PowerPoint Presentation: About 2% of people over 60 have undiagnosed pernicious anemia . Most common in whites of Northern European ancestry. Average age of diagnosis is approx 60. Under age 30, it is usually associated with other autoimmune disease. – 4.1% prevalence in women. 2.1% incidence in men. " EPIDEMIOLOGY " PowerPoint Presentation: Vitamin B12 is a nutrient found in some foods. The body needs this nutrient to make healthy red blood cells and to keep its nervous system working properly. " VITAMIN B-12 " PowerPoint Presentation: " FOLIC ACID " a B vitamin important in the synthesis of nucleic acid. Deficiency results in megaloblastic anemia. during pregnancy prevent from neural tube defects (spina bifida and other congenital malformations) PowerPoint Presentation: Megaloblastic anemia is usually caused by a deficiency of folic acid or vitamin B12 . Poor diet pregnancy Lack of intrinsic factor. Malabsorption in the small intestine. Other less common causes are: Alcohol abuse Certain inherited disorders Drugs that affect DNA, such as chemotherapy drugs Leukemia Myelodysplastic syndrome Myelofibrosis " CAUSES " PowerPoint Presentation: Have a family history of the condition. Have had part or all of your stomach surgically removed.. Have an autoimmune disorder that involves the endocrine glands, such as Addison's disease, type 1 diabetes, Graves' disease, or vitiligo. Have had part or all of your small intestine surgically removed. Have certain intestinal diseases or other disorders that may prevent your body from properly absorbing vitamin B12. Examples include Crohn's disease, intestinal infections, and HIV. medicines that prevent your body from properly absorbing vitamin B12. Examples include antibiotics and certain seizure medicines. strict vegetarian who doesn't eat any animal or dairy products and doesn't take a vitamin B12 supplement. " RISK FACTOR " PowerPoint Presentation: Some of the signs and symptoms of pernicious anemia apply to all types of anemia. Other signs and symptoms are specific to a lack of vitamin B12. " SIGN & SYMPTOMS " PowerPoint Presentation: nerve damage tingling and numbness in hands and feet. muscle weakness loss of reflexes feel unsteady lose your balance trouble walking weakened bones hip fractures Nausea and vomiting heartburn abdominal bloating constipation or diarrhea, loss of appetite weight loss Hepatomegaly SPECIFIC PowerPoint Presentation: Severe vitamin B12 deficiency can cause neurological problems: Confusion Dementia Depression memory loss. Fever&sore throat A smooth, thick, red tongue also is a sign of vitamin B12 deficiency and pernicious anemia. Infants have poor reflexes,unusual movements, such as face tremors. Irritable permanent growth problems. SPECIFIC PowerPoint Presentation: Medical and Family Histories Physical Exam Diagnostic Tests and Procedures Complete Blood Count Reticulocyte count Serum folate, iron, and iron-binding capacity tests. " DIAGNOSTIC WORK-UP " PowerPoint Presentation: Serum methylmalonic acid (MMA) level Serum vitamin B12 level Serum LDH Schilling test Bone Marrow Tests PowerPoint Presentation: Schilling, Robert Frederick ( born 1919), American hematologist. Schilling undertook research on the absorption and utilization of vitamin B12, the mechanisms involved in the causation of anemia, and on the gastrointestinal absorption of nutrients. He introduced the Schilling test in 1953. " SCHILLING TEST " PowerPoint Presentation: This test may be performed in four different stages to find the cause of low vitamin B12 levels. STAGE I: You will get two doses of vitamin B12 (cobalamin). You will take a small, first dose (a radioactive form of B12) by mouth. You will a second, larger dose by a shot 1 hour later. You will need to collect your urine over the next 24 hours, and deliver it to a lab or your doctor's office. The urine will be checked to see if you are absorbing vitamin B12 normally. For information on collecting the urine sample, see: 24-hour urine collection If Stage I is abnormal, Stage II may be done 3 - 7 days later. " How the Test is Performed " PowerPoint Presentation: STAGE II: You are given radioactive B12 along with intrinsic factor. Intrinsic factor is a protein produced by cells in the stomach lining. The body needs it so the intestines can absorb vitamin B12 efficiently. Stage II of the test can tell whether low vitamin B12 levels are caused by problems in the stomach that prevent it from producing intrinsic factor. If a Stage II test is abnormal, a Stage III test is performed. PowerPoint Presentation: STAGE III: This test is done after you have taken antibiotics for 2 weeks. It can tell whether abnormal bacterial growth has caused the low vitamin B12 levels. STAGE IV: This test determines whether low vitamin B12 levels are caused by problems with the pancreas. With this test, you will take pancreatic enzymes for three days, followed by a radioactive dose of vitamin B12. PowerPoint Presentation: Do not eat for 8 hours before starting the test, then eat normally for the next 24 hours. You can drink water. The health care provider may ask you to stop taking drugs that can affect the test. You cannot have intramuscular injection B12 within 3 days before the test. How to Prepare for the Test PowerPoint Presentation: Normal Results Urinating 8 - 40% of the radioactive vitamin B12 within 24 hours is normal. Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results. “What Abnormal Results Mean” Low vitamin B12 levels can cause megoblastic anemia . If there is a problem with the stomach's ability to make intrinsic factor, Stage I of the test will be abnormal and Stage II will be normal. Both the Stage I and II Schilling tests will be abnormal in people who have problems absorbing vitamin B12 and intrinsic factor in the small intestine. PowerPoint Presentation: The goals of treating pernicious anemia include: Preventing or treating the anemia and its signs and symptoms Preventing or managing complications, such as heart and nerve damage Treating the cause of the pernicious anemia (if a cause can be found) " TREATMENT " PowerPoint Presentation: Folic acid supplements may be given by mouth (oral) or through a vein (intravenous) on a short-term basis until the anemia has been corrected. In the case of poor absorption by the intestine -- replacement therapy may be lifelong. " TREATMENT OF FOLIC ACID DEFICIENCY " PowerPoint Presentation: Enriched wheat Enriched white bread Enriched pasta cooked Sunflower seeds Spinach raw, cereals Aspargus, beans Grape fruit Pineapple Pinto beans, peanuts Orange juice " FOOD " PowerPoint Presentation: Symptoms of anemia can cause discomfort. In pregnant women, folate deficiency has been associated with neural tube or spinal defects (such as spina bifida ) in the infant. Other, more severe complications may include: Curly graying hair Increased skin color (pigment) Infertility Worsening of heart disease or heart failure " COMPLICATIONS " PowerPoint Presentation: " TREATMENT OF VIT B-12 DEFICIENCY " A well-balanced B12 diet is essential. vitamin B12 supplements by mouth in addition to monthly injections Monthly vitamin B12 injections are prescribed to correct the vitamin B12 deficiency. PowerPoint Presentation: Vitamin B12 is naturally found in animal products: including fish, meat, poultry, eggs, milk, and milk products. Vitamin B12 is generally not present in plant foods, but fortified breakfast cereals are a readily available source of vitamin B12. Some nutritional yeast products also contain vitamin B12. " FOOD " Recommended Dietary Allowances : Recommended Dietary Allowances LACTATION PREGNANCY FEMALE MALE AGE 0.4mcg 0.4mcg 0-6 months * 0.5mcg 0.5mcg 7-12 months 0.9mcg 0.9mcg 1-3 years 1.2mcg 1.2mcg 4-8 years 1.8mcg 1.8mcg 9-13 years 2.8mcg 2.6mcg 2.4mcg 2.4mcg 14+ years PowerPoint Presentation: People with pernicious anemia may have gastric polyps, and they are at increased risk for gastric cancer and gastric carcinoid tumors. Brain and nervous system (neurological) problems may continue if treatment is delayed " COMPLICATIONS " : The outcome is usually excellent with treatment. Any damage to nerves may be permanent, especially if treatment is not started within 6 months of when symptoms began. " PROGNOSIS "