Edit concept Question Editor Create issue ticket

Refractory Megaloblastic Anemia


Presentation

  • We present a case with refractory megaloblastic anemia with asymptomatic falciparum malaria.[unboundmedicine.com]
  • […] including its relationship with Other systems and disorders Internal medicine Immunology Microbiology Histopathology Clinical chemistry Essentially an annotated index, The CRC Desk Reference for Hematology provides an accessible reference, featuring a novel presentation[books.google.de]
  • Born 27 May 1975 (1975 05 27) (age 36) Kolar, Karnataka, India Education Bangalore Medical College Karnataka Years active 1999 present … Wikipedia Paroxysmal nocturnal hemoglobinuria — Classification and external resources ICD 10 D59.5 ICD 9 283.2 … Wikipedia[translate.academic.ru]
Hemophilia A
  • A, congenital factor VIII disorder 286.1 Hemophilia B, congenital factor IX disorder 289.89 Hypercoagulable state, unspecified 289.89 Hypergammaglobulinemia 280.9 Iron deficiency anemia, unspecified 288.60 Leukocytosis/leucocytosis V58.61 Long-term ([hemonc.org]
Refractory Anemia
  • The peripheral blood smear of refractory anemia with ringed sideroblasts is characterized by a dimorphic red cell population.[5minuteconsult.com]
  • B12 or folate deficiency - 21% Drug intake - 11% Accelerated erythropoiesis - 7% Liver disease - 6% Refractory anemias - 5% Hypothyroidism - 2% Unexplained - 12% Data from several sources quoted by Colon-Othero et al.[enotes.tripod.com]
  • Acquired sideroblastic anemia is often the earliest evidence of a myelodysplastic syndrome (MDS) - refractory anemia with ringed sideroblasts.[med-ed.virginia.edu]
  • […] entity exhibiting features of both RARS and Essential Thrombocythemia Note In at least some patients this represents acquisition of a prothrombocythemic JAK2 mutation in a background of RARS Diagnostic Criteria Must satisfy diagnostic features of RARS Refractory[surgpathcriteria.stanford.edu]
  • anemia with excess blasts ** (n) コーパス RAEB ** (n,abrv) コーパス 芽球増加を伴う不応性貧血 D462 ** がきゅうぞうかをともなうふおうせいひんけつ シソーラス PubMed , Scholar , Google , WikiPedia 【類義語】 芽球増加型不応性貧血 refractory anemia with excess blasts ** (n) コーパス RAEB ** (n,abrv) コーパス 急性貧血 *** きゅうせいひんけつ[lsd-project.jp]
Asymptomatic
  • We present a case with refractory megaloblastic anemia with asymptomatic falciparum malaria.[unboundmedicine.com]
  • Clinical features• Asymptomatic - Many patients are diagnosed on routine laboratory screening• Fatigue, weakness, angina - as a result of anemia.• Infections most commonly bacterial, predominate with skin being the most common site.[slideshare.net]
Collapse
  • On the third day of therapy, he had a sudden deterioration of clinical state and developed cardiovascular collapse. In spite of upgrading antibioticsand aggressive management, the child could not be revived.[tropej.oxfordjournals.org]
Constitutional Symptom
  • symptoms Lab features Decreased serum iron and ferritin (a measure of total body iron stores) Increased total iron binding capacity— transferrin is less saturated with iron and increased capacity for transporting iron exists Anemia of chronic disease[brainscape.com]
Infertility
  • . - Reversible melanin skin pigmentation - Bruising (due to thrombocytopenia) - Increased risk of infection (due to low WBC counts) - Infertility (as gonads are affected) Maternal folate deficiency · Prematurity · Recurrent fetal loss · Neural tube defects[sites.google.com]
Sore Throat
  • He had no history of fever, joint pains, recurrent diarrhea or sore throat. He had not received any blood transfusions previously. There was no history of similar complaints in the family. His dietary intake was adequate.[tropej.oxfordjournals.org]
Pharyngitis
  • […] unspecified 787.91 Diarrhea 008.45 Diarrhea, C. diff (Clostridium difficile) 719.7 Difficulty in walking 453.9 I82.91 Deep vein thrombosis (DVT), unspecified site 536.8 Dyspepsia 787.20 Dysphagia, unspecified 787.21 Dysphagia, oral phase 787.22 Dysphagia, pharyngeal[hemonc.org]
Recurrent Diarrhea
  • He had no history of fever, joint pains, recurrent diarrhea or sore throat. He had not received any blood transfusions previously. There was no history of similar complaints in the family. His dietary intake was adequate.[tropej.oxfordjournals.org]
Petechiae
  • Thrombocytopenia typically manifests as petechiae or ecchymoses; epistaxis and gum bleeding suggest severe thrombocytopenia. Hemoptysis, hematuria, and blood in stools may occur.[emedicine.medscape.com]
  • […] abdominal-RUQ 338.11 Pain, acute due to trauma 338.18 Pain, acute post-operative 724.5 Pain, back general 724.2 Pain, back lumbar 338.21 Pain, chronic due to trauma 338.28 Pain, chronic NOS 338.3 Pain, neoplasm related 785.1 Palpitations 567.9 Peritonitis 782.7 Petechiae[hemonc.org]
Fear
  • She provides a window into these women's lives, brilliantly portraying their hopes and fears and their struggle to live with dignity.[books.google.de]

Workup

  • Clinical symptoms that should prompt a workup for MDS are due to low peripheral blood counts, usually from the anemia but also from the thrombocytopenia or neutropenia. Symptoms such as fatigue and malaise result from anemia.[emedicine.medscape.com]
  • Investigative workup revealed normochromic macrocytic anemia with mild anisocytosis (Hb 4.8 g/dl) [Table 1] . Liver function, kidney function, urinalysis, chest roetgenography, and electrocardiography were normal.[ijem.in]
Macrocytic Anemia
  • Examples include causesof splenomegaly, indications for splenectomy, differential diagnosis of normocytic anemia,macrocytic anemia, hypochromic anemia, thrombocytopenia, bone marrow failure syndromes, and manyothers.[books.google.de]
  • […] blood or of typical megaloblasts in the marrow ) The nonmegaloblastic anemias (they simply represent macrocytic anemias in which DNA synthesis is unimpaired.[enotes.tripod.com]
  • Clinical signs macrocytic normochromic anemia pernicious anemia: also atrophic glossitis, atrophic gastritis, neurologic disorders Histology Peripheral blood: normochromic macrocytic anemia, often pancytopenia, significant anisocytosis, poikilocytosis[atlases.muni.cz]
  • Algorithm for the evaluation of macrocytic anemia. (RBC red blood cell; MMA methylmalonic acid.) Evaluation of Macrocytic Anemia Figure 3. Algorithm for the evaluation of macrocytic anemia. (RBC red blood cell; MMA methylmalonic acid.)[aafp.org]
  • SUMMARY Deficiency of either folate or cobalamin (vitamin B 12 ) leads to macrocytic anemia with or without other cytopenias as a result of megaloblastic hematopoiesis, a manifestation of defective DNA synthesis.[accessmedicine.mhmedical.com]
Macrocytosis
  • However, this concept remains useful for identifying the most predominant etiology for macrocytosis.[aafp.org]
  • B 12 deficiency - macrocytosis, hypersegmented neutrophils, low plasma vit. B12 level .[enotes.tripod.com]
  • Megaloblastic anemia and other causes of macrocytosis. Clin Med Res . 2006;4(3):236–241. [View Abstract on OvidInsights] Kaferle J, Strzoda CE.[5minuteconsult.com]
  • . • Particularly apparent in cases of hypoplastic MDS that share a number of features in common with aplastic anaemia, notably clinical presentation with macrocytosis and varying levels of dyserythropoiesis• Acquired mutations in the PIG-A gene characteristic[slideshare.net]
  • […] methylene tetrahydrofolate reductase & in mothers who have autoantibodies to folate receptors) - (Prophylaxis during pregnancy also prevents ALL in children) Neurological manifestations due to cobalamine deficiency (Sometimes occurs without anemia or macrocytosis[sites.google.com]
Anisopoikilocytosis
  • Peripheral smear revealed anisopoikilocytosis, macro-ovalocytes with decreased TLC and reduced platelets. The liver and kidney function tests were normal. The blood and urine cultures were repeatedly sterile.[tropej.oxfordjournals.org]
  • . • PB smear shows abnormality in all three lines• Red cell anisopoikilocytosis• Large , giant or hypogranular platelets• Abnormal cytoplasmic granularity & nuclear segmentation of neutrophils .[slideshare.net]
Plasmodium Falciparum
  • Introduction Anemia is a well-known complication of Plasmodium falciparum malaria [ 1 ]. Various pathophysiological mechanisms underlie the onset of anemia in this infection.[tropej.oxfordjournals.org]
  • falciparum Platelet Transfusion Vitamin B 12 Vitamin B Complex Pub Type(s) Case Reports Journal Article Language eng PubMed ID 20889623 TY - JOUR T1 - Refractory pancytopenia and megaloblastic anemia due to falciparum malaria.[unboundmedicine.com]
Lymphocytic Infiltrate
  • PAS stain … Wikipedia Coeliac disease — Classification and external resources Biopsy of small bowel showing coeliac disease manifested by blunting of villi, crypt hyperplasia, and lymphocyte infiltration of crypts ICD 10 … Wikipedia[translate.academic.ru]

Treatment

  • The etiology, clinical features and treatment of 25 cases of idiopathic refractory megaloblastic anemia are described. Attention is directed to the excellent therapeutic effects produced by proteolysed liver or folic acid. 3.[bloodjournal.org]
  • Myelodysplastic Syndromes Treatment (PDQ )–Health Professional Version. National Cancer Institute. Available at . April 2, 2015; Accessed: November 20, 2017. Saunthararajah Y.[emedicine.medscape.com]
  • , 50% mortality at 18 months Increased risk of thrombotic and hemorrhagic complications Has been linked to Budd-Chiari Syndrome With treatment patients can live for years to decades Usual cause of death in treated patients is progressive marrow fibrosis[brainscape.com]
  • Treatment should be focused on the underlying cause of hemolysis or hemorrhage.[aafp.org]

Prognosis

  • PMID 2319806 International scoring system for evaluating prognosis in myelodysplastic syndromes.[atlasgeneticsoncology.org]
  • • Unravel disease biology• Design accurate diagnostic tests• Predict prognosis• Develop novel therapies 12.[slideshare.net]
  • […] carbohydrate solutions (D5 or D10) Hemin infusion—similar molecule to heme which decreases porphyrin production (negative feedback effect) and terminates an attack Beta blockers—for tachycardia and hypertension Analgesics Acute intermittent porphyria prognosis[brainscape.com]
  • International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood . 1997 Mar 15. 89(6):2079-88. [Medline] . [Full Text] . Greenberg PL, Tuechler H, Schanz J, Sanz G, Garcia-Manero G, et al.[emedicine.staging.medscape.com]

Etiology

  • The etiology, clinical features and treatment of 25 cases of idiopathic refractory megaloblastic anemia are described. Attention is directed to the excellent therapeutic effects produced by proteolysed liver or folic acid. 3.[bloodjournal.org]
  • NY, 1998, pg 653 classification (etiology) of megaloblastic anemia Retrieved from " "[anvita.info]
  • The most common etiologies are alcoholism, vitamin B 12 and folate deficiencies, and medications.[aafp.org]
  • Pyrimidine antagonists (5-FU, cytosine arabinoside …etc) Others (procarbazine, hydroxyurea, acyclovir, zidovudine) 2- Metabolic disorders Hereditary Orotic aciduria Lesch-Nyhan syndrome 3- Megaloblastic anemia of unknown etiology Refractory Megaloblastic[nanopdf.com]
  • […] in whom chronic steroid use is required "Georgia's warm" Cold- immune mediated hemolytic anemia cold reacting antibodies (occurs below body temperature and is mediated by IgM) Complement may directly lyse RBCs or opsonize RBCs for lysis in the spleen Etiology[brainscape.com]

Epidemiology

  • Epidemiology There are few data on the epidemiology of RA, which may account for 30-40% of all MDS cases. MDS is predominantly diagnosed in the elderly population.[atlasgeneticsoncology.org]
  • Epidemiology of myelodysplastic syndromes and chronic myeloproliferative disorders in the United States, 2001-2004, using data from the NAACCR and SEER programs. Blood . 2008 Jul 1. 112(1):45-52. [Medline] . [Full Text] . Ma X.[emedicine.staging.medscape.com]
  • ., Tateda, K. (2018) Molecular epidemiology of Klebsiella pneumoniae K1 and K2 isolates in Japan. Diagn Microbiol Infect Dis., 91, 354-359.[med.akita-u.ac.jp]
Sex distribution
Age distribution

Pathophysiology

  • Various pathophysiological mechanisms underlie the onset of anemia in this infection.[tropej.oxfordjournals.org]
  • […] protein deficiency) Lead poisoning Leukemia Liver disease/Liver disorders Malabsorption of folic acid Malnutrition / Starvation Megaloblastic anemia Megaloblastic anemia of pregnancy Methotrexate ( Rheumatrex ) Administration/Toxicity Myeloid metaplasia pathophysiology[wikidoc.org]
  • Alcohol 26 65 15 36 B 12 and/or folate deficiency 6 9 28 21 Medications 37* 3 2 11 Hypothyroidism — 1 12 5 Bone marrow dysplasias 6 1 5 5 Liver disease (nonalcoholic) 6 — 2 6 Reticulocytosis 8 — — 7 Miscellaneous 3 21 13 7 Not established 7 — 22 12 Pathophysiology[aafp.org]

Prevention

  • CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question * Phone[malariaworld.org]
  • To the contrary, high levels of the T helper type 2 produced cytokine interleukin-10 (IL-10) might prevent the development of severe malarial anemia. Low levels of IL-10 have been described in African children with severe malarial anemia [ 13 ].[tropej.oxfordjournals.org]
  • If glutamylation is prevented, the folates cannot be retained in the cell, resulting in an intracellular folate deficiency.[accessmedicine.mhmedical.com]
  • Although adequate iron is present, a mitochondrial defect (decreased activity of D-ALA or ferrochelatase) prevents the incorporation of iron into hemoglobin.[med-ed.virginia.edu]
  • . - Prevented by 0.4mg folic acid daily.[sites.google.com]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!