eMedicine Specialties > Pediatrics: General Medicine > Hematology

Anemia, Megaloblastic: Follow-up

Author: James L Harper, MD, Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Assistant Clinical Professor, Department of Pediatrics, Creighton University; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center
Contributor Information and Disclosures

Updated: Sep 9, 2009

Follow-up

Complications

  • Neurologic complications are frequent problems in patients with megaloblastic anemia due to B-12 deficiency. These may be observed in any age group and may be at least partially reversible with repletion of the B-12 deficit.

Prognosis

  • Prognosis depends on the underlying cause of the megaloblastic anemia and the degree of compliance with therapy.
  • Folic acid deficiency is relatively easy to treat; patients usually respond to added folate in their diet.
  • Vitamin B-12 deficiency may be a more significant concern because some patients may need to use parenteral vitamin B-12 injections, with which they may not readily comply.
  • Vitamin B-12 deficiency may be associated with severe abnormalities of neural function that may be long lasting and persist even with appropriate vitamin B-12 therapy.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis of vitamin B-12 deficiency
    • Avoid delaying or misdiagnosing vitamin B-12 deficiency.
    • Folic acid supplementation may be sufficient to drive the production of active 5 methyl tetrahydrofolate (THF) in the absence of vitamin B-12. This results in improvement of the anemia but does not result in improvement of the function of other pathways dependent on B-12. Clinically, this is apparent as a resolution of megaloblastic anemia, with progressive dementia and long-tract neurologic deficits. This situation can be avoided by measuring levels of both vitamins, then evaluating and treating both deficiencies, if found.

Special Concerns

  • Dietary B-12 deficiency in infants is extremely rare. It is often observed in infants who are breastfed by mothers who have B-12 deficiency. Consider this prospect if a breastfed infant has B-12 deficiency for an apparent dietary reason.
 


More on Anemia, Megaloblastic

Overview: Anemia, Megaloblastic
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Treatment & Medication: Anemia, Megaloblastic
Follow-up: Anemia, Megaloblastic
Multimedia: Anemia, Megaloblastic
References
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References

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Further Reading

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Keywords

vitamin B-12 deficiency, folate deficiency, folic acid deficiency, tetrahydrofolic acid deficiency, THF, vitamin deficiency, gastrointestinal disease, megaloblastic anemia, anemia, DNA synthesis defect, folate deficiency, purine biosynthesis, thrombocytopenia, leukopenia, celiac sprue, B-12 deficiency, folate, vitamin B-12, B-12, cobalamin deficiency, thiamine-responsive megaloblastic anemia, Lesch-Nyhan syndrome, HIV infection, AIDS, learning disorders, treatment, diagnosis

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Contributor Information and Disclosures

Author

James L Harper, MD, Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Assistant Clinical Professor, Department of Pediatrics, Creighton University; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center
James L Harper, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Federation for Clinical Research, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Council on Medical Student Education in Pediatrics, and Hemophilia and Thrombosis Research Society
Disclosure: Nothing to disclose.

Medical Editor

Sharada A Sarnaik, MBBS, Professor of Pediatrics, Wayne State University School of Medicine; Director, Sickle Cell Center, Attending Hematologist/Oncologist, Children's Hospital of Michigan
Sharada A Sarnaik, MBBS is a member of the following medical societies: American Association of Blood Banks, American Association of University Professors, American Society of Hematology, American Society of Pediatric Hematology/Oncology, New York Academy of Sciences, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Steven K Bergstrom, MD, Assistant to the Chairman, Department of Pediatrics, Division of Hematology-Oncology, Kaiser Permanente Medical Center of Oakland
Steven K Bergstrom, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and International Society for Experimental Hematology
Disclosure: Nothing to disclose.

CME Editor

Samuel Gross, MD, Professor Emeritus, Department of Pediatrics, University of Florida; Clinical Professor, Department of Pediatrics, University of North Carolina; Adjunct Professor, Department of Pediatrics, Duke University
Samuel Gross, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA, Senior Vice President, Children's National Medical Center (Center for Cancer and Blood Disorders); Director, Center for Cancer and Immunology Research, Children's Research Institute, Children's National Medical Center; Professor of Medicine, Oncology, and Pediatrics, Georgetown University
Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American Association for Cancer Research, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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