Looking to book a COVID-19 PCR Test? Book Now

How to Treat Anaemia Megaloblastic?


Things to note:
  • Dietary modifications to ensure adequate intake of folate and vitamin B12.
  • Identify and treat the underlying cause, e.g. antibiotics for intestinal overgrowth with bacteria.

Medical Treatment:
  • After blood samples for RBC, folate and vitamin B12 levels have been taken, start with folic acid and vitamin B12.
  • Monitor serum potassium and replace if necessary.
  • Give vitamin B12 and folic acid together until the test results are available as giving folic acid alone in patients with a B12 deficiency may precipitate a permanent neurological deficit.
Adjust management according to results.
Folic acid deficiency
  • Folic acid, oral, 5 mg daily until haemoglobin returns to normal.
  • Prolonged treatment may be required for malabsorption states.
Vitamin B12 deficiency
  • Vitamin B12, IM.
  • 1 mg daily for 5 days, then weekly for a further 3 doses.
  • Follow with 1 mg every second month for life in patients with pernicious anaemia, except in patients with clearly modifiable nutritional deficiency.
Note:
Response to treatment is associated with an increase in strength and improved sense of well-being.
Reticulocytosis begins 3-5 days after therapy and peaks at about day 7.The anaemia is corrected within 1-2 months. The white cell count and platelets normalise in 7-10 days. As there is an increase in red blood cell production, short-term iron and folic acid supplementation is also recommended.
Consider the following if there is failure to respond:
  • Co-existing folate and/or iron deficiency,
  • Infection,
  • Hypothyroidism,
  • Myelodysplasia,
  • Incorrect diagnosis,and
  • Drug-induced, e.g. hydroxyurea, stavudine and zidovudine.
Prophylaxis
Vitamin B12 is indicated for patients after total gastrectomy or ileal resection.
  • Vitamin B12, IM, 1 mg every second month for life.
Indications for folic acid:
  • Chronic inherited haemolytic anaemias, e.g. sickle cell anaemia, thalassaemia.
  • Myeloproliferative disorders.
  • Exfoliative skin disorders.
  • Increased demands, e.g. pregnancy, chronic haemodialysis.
  • Folic acid, oral, 5 mg daily.