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Megaloblastic Anaemia in Pregnancy

Megaloblastic Anemia Due to Pregnancy


Presentation

  • It should be considered in any patient who presents with pyrexia with pancytopenia.[thejh.org]
  • Conclusion Although microcytic hypochromic anemia is the most frequent type of anemia in pregnancy in our setting, megaloblastic anemia is also present. Both are present in some women.[panafrican-med-journal.com]
  • Clinically detectable malnutrition was not present. 2. This anaemia was found to be the commonest megaloblastic anaemia encountered among Africans and Indians. 3. One patient died of suppurative pyelonephritis.[journals.co.za]
  • Recent observations have indicated that folate deficiency, in addition to being responsible for anemia, may be present during late pregnancy without anemia (5) and may be FULL TEXT[annals.org]
  • There are also a number of rare hereditary conditions causing defects in DNA synthesis that can result in megaloblastic anaemia. 3 These usually present in infancy.[bpac.org.nz]
Pallor
  • […] most common medical disorder of pregnancy 15-60% fatigue, weakness, malaise, pallor, dyspnea, anorexia and/or pica, edema, more susceptible to infection, may be asymptomatic. hemoglobin normals for nonpregnant women- 12-16 hematocrit normals for nonpregnant[quizlet.com]
  • Symptoms may include: Fatigue Weakness Headache Pallor Sore mouth and tongue The goal is to identify and treat the cause of the folate deficiency.[medlineplus.gov]
  • Other symptoms and signs may include pallor and, if anemia is severe, tachycardia or hypotension.[merckmanuals.com]
  • Enlargement of liver and spleen (hepatosplenomegaly) may also occur, accompanied by yellow discoloration of the skin (jaundice) or pallor. Weakness, heart palpitations, difficulty breathing, as well as pain in the limbs are other possible symptoms.[diagnose-me.com]
  • Signs: Pallor which can be detected in the face, palm of the hand, nail bed and mucus membranes of the mouth and conjunctiva. Angular stomatitis and red glazed tongue. Nails are brittle, striated with loss of their lustre.[gfmer.ch]
Weight Gain
  • Department vitamin B12 weight gain young معلومات المراجع العنوان Maternal Nutrition and the Course of Pregnancy المجلد 2114 من Public Health Service publication المساهم National Research Council (U.S.).[books.google.com]
  • .  If any of the below suspected, as the below are common in pregnancy: – Maternal risks during Antenatal period: Poor weight gain, preeclampsia, eclampsia, placenta previa, accidental haemorrhage, premature rupture of membranes, pre term labour, cardiac[speciality.medicaldialogues.in]
Steatorrhea
  • […] atrophy seen in cobalamin deficiency Abdominal scars: may suggest a blind loop syndrome due to gastric surgery or a lack of ileal absorption of cobalamin due to ileal resection Signs of malabsorption: weight loss, abdominal distention, diarrhea and steatorrhea[pathologyoutlines.com]

Workup

  • Physical examination and clinical workup may uncover findings such as pale tongue, conjunctiva, numbness, heart murmur, and other symptoms Megaloblastic Anemia is diagnosed by performing blood tests that include: Serum B12 level Serum methylmalonic acid[dovemed.com]
  • Patients with vitamin B-12 deficiency need further workup to determine the level of intrinsic factor to exclude pernicious anemia. The Schilling test is not recommended during pregnancy, because of the radionuclide used in testing.[emedicine.medscape.com]
  • Many of these (HbA-C, HbC-C, HbA-D, heterozygous thalassemia) are usually diagnosed only during the workup of a patient with mild, iron-unresponsive anemia. 112[glowm.com]

Treatment

  • Ministry of Health and Family Welfare, Government of India has issued the Standard Treatment Guidelines for Anemia In Pregnancy.[speciality.medicaldialogues.in]
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you. Know why a new medicine or treatment is prescribed, and how it will help you.[hopkinsmedicine.org]
  • Oral medications are also available for treatment. Folate Deficiency Treatment: Oral doses of 5-15 mg folic acid daily are sufficient. The duration of treatment depends on the underlying disease. It is usually necessary to treat for about 4 months.[medindia.net]
  • Some people never need treatment.[webmd.com]
  • Alcohol should be avoided by the patients while treatment is on. Psychiatric treatment accompanied by substance abuse counseling should be administered to the patients if necessary.[hxbenefit.com]

Prognosis

  • Megaloblastic Anemia Prognosis The outcome can be promising for MA patients if the underlying causes behind megaloblastosis are identified and proper treatment measures are opted for.[hxbenefit.com]
  • Effect on pregnancy: ß-Thalassaemia major is rarely encountered in pregnant women, but if this happened the prognosis is poor. Anaemia becomes severe in mid-pregnancy and may result in heart failure.[gfmer.ch]
  • The prognosis for mother and fetus is dependent on the prognosis of the underlying disease process. Intrinsic hemolytic anemia Intrinsic hemolytic anemias are those in which there are inherited disorders leading to premature destruction of the RBCs.[glowm.com]
  • Mocroft A, Kirk O, Barton SE, Dietrich M, Proenca R, et al. (1999) Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe. EuroSIDA study group. AIDS 13: 943–950.[journals.plos.org]

Etiology

  • The most common etiologies are alcoholism, vitamin B 12 and folate deficiencies, and medications.[aafp.org]
  • […] folate occurs in the jejunum and throughout the small intestine The physiological absorption and transport of folate is receptor mediated In contrast to cobalamin, there is no equivalent of intrinsic factor to stabilize and transport ingested folate Etiology[pathologyoutlines.com]
  • Laboratory tests that may be helpful to distinguish between SCC and other possible etiologies of pain include a white blood cell (WBC) count with differential and lactic dehydrogenase (LDH) determinations.[emedicine.medscape.com]
  • Etiology Causes of anemia include: Nutritional deficiency (e.g., iron deficiency or megaloblastic anemia, which includes folic acid deficiency and B12 deficiency).[rnpedia.com]
  • After ruling out infections and inflammatory conditions, which are important causes of fever in patients having pancytopenic picture, we should consider this possibility to be the etiological cause of fever.[thejh.org]

Epidemiology

  • This problem was addressed by Pelletier and colleagues (1993) in discussing the epidemiological evidence for a potentiating effect of malnutrition on child mortality.[jn.nutrition.org]
  • In patients with liver disease and obstructive jaundice, cholesterol and/or phospholipids become deposited on the membranes of circulating red blood cells, leading to larger than normal cells. [ 1 ] Epidemiology [ 2 ] One study found that the most common[patient.info]
  • Megaloblasts: Large cells with an increased nuclear/cytoplasmic ratio with delayed nuclear maturation but more advanced cytoplasmic maturation Megaloblasts are usually abundant in bone marrow aspirates and can also be seen on peripheral blood smear Epidemiology[pathologyoutlines.com]
  • Moderate alcohol consumption and breast cancer in women: from epidemiology to mechanisms and interventions. Alcohol Clin Exp Res. 2013;37(1):23-30. (PubMed) 122. Rohan TE, Jain MG, Howe GR, Miller AB.[lpi.oregonstate.edu]
Sex distribution
Age distribution

Pathophysiology

  • ., sickle cell anemia, thalassemia, or glucose-6-phosphate dehydrogenase [G-6-PD]) Pathophysiology The hemoglobin level for nonpregnant women is usually 3.5 g/dL.[rnpedia.com]
  • […] like methotrexate Pyrimidine antagonists like cytosine arabinoside Purine synthesis antagonists like 6-mercaptopurine Chemotherapy drugs like trimethoprim or azathioprine Erythroleukemia Leukemia Myelofibrosis Myelodysplastic syndrome HIV Infection Pathophysiology[hxbenefit.com]
  • […] one child [4] Teenage pregnancy Severe morning sickness causing excessive vomiting [9] History of anemia before conceiving Poor diet (low in iron and vitamins) Excessive pre-pregnancy menstrual flow History of hemorrhoids or stomach ulcers Causes and Pathophysiology[pregmed.org]
  • Pathophysiology of Megaloblastic Anemia Megaloblastic anemia is due to a variety of DNA synthesis defects. In the case of folate deficiency, purine biosynthesis is affected as folic acid is important in this process.[findatopdoc.com]
  • ., higher incidence in Sweden, Denmark, United Kingdom Sites Primarily bone marrow and peripheral blood are affected Pathophysiology General principles: The common feature in megaloblastosis is a defect in DNA synthesis in the rapidly dividing cells To[pathologyoutlines.com]

Prevention

  • Therefore, preventive measures are needed if anemia and its adverse effects are to be prevented.[intechopen.com]
  • How to Prevent Megaloblastic Anemia? Dietary intake of both cobalamin and folic acid should be adequate. Foods that are rich in cobalamin are eggs, chicken, meat, milk, cheese and fish.[medindia.net]
  • […] causes prevention- adequate levels of folic acid prior to pregnancy. recommended intake- 0.4mg folic acid daily causes- poor diet susceptible to infection at risk for hemorrhage folic acid fetal/neonatal risk neural tube defects cleft lip or palate at[quizlet.com]
  • Prevent or treat non-dietary causes of anaemia.[southsudanmedicaljournal.com]

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