Megaloblastic anemia: causes, symptoms and treatment

Definition

What is megaloblastic anemia?

Megaloblastic anemia is a type of anemia characterized by an abnormal shape of the red blood cell strip and a larger size.

Normal red blood cells should be flat, round discs that are slightly indented in the middle. However, in this case of anemia, the pieces of red blood cells are oval in shape.

This abnormal shape and size occurs because red blood cells do not divide and do not develop completely. As a result, the number of normal and healthy red blood cells is not enough.

This blood disorder also causes the bone marrow to produce fewer cells. Normal red blood cells generally last about 90-120 days before being destroyed by the body to be replaced with new ones.

However, in this case, the red blood cells are sometimes destroyed or die sooner than they should.

How common is this condition?

Megaloblastic anemia is a condition that can occur in men or women of any racial or ethnic background. However, it is not certain how many people in the world have this type of anemia.

Signs and symptoms

What are the signs and symptoms of megaloblastic anemia?

The characteristics of megaloblastic anemia are similar to the symptoms of anemia in general, such as weakness and fatigue and dizziness and pale skin. On the other hand, some people may not show obvious symptoms.

Quoted from the Mayo Clinic, common symptoms of megaloblastic anemia are:

• Hard to breathe
• Numbness at each end of the body; eg fingertips and toes
• Swollen tongue
• Diarrhea
• Nausea
• Muscle cramp
• Skin looks pale
• Loss of appetite and drastic weight loss.
• Heart beat
• Hand and foot tremors

Some of the symptoms of megaloblastic anemia associated with digestive problems can trigger nerve damage. If left untreated for a long time, this condition can lead to decreased bone density and the development of gastric cancer.

Cause

What causes megaloblastic anemia?

The causes of anemia can vary depending on the type. The main cause of megaloblastic anemia is a lack of intake of vitamin B12 and folic acid (vitamin B9).

Vitamin B12 and folic acid are included as the main ingredients for making red blood cells. Lack of these two nutrients can result in the bone marrow being unable to produce healthy and normal blood components in sufficient quantities.

This also results in the resulting red blood cells that are not normal in shape and size. These damaged or incompletely shaped red blood cells will die faster than healthy ones.

Lack of red blood cells causes hemoglobin levels contained in the blood to be less. In fact, hemoglobin plays an important role in binding oxygen and nutrients to blood cells and then circulating it throughout the body.

Not only red blood cells, megaloblastic anemia also reduces granulocytes (white blood cells that have granules in their cytoplasm) and platelets.

Reporting from the National Center for Biotechnology Information, in rarer cases, this type of anemia occurs due to heredity, such as:

• Thiamine-responsive megaloblastic anemia syndrome (vitamin B1), a disease characterized by megaloblastic anemia associated with hearing loss and diabetes mellitus.
• Imerslund-Grasbeck syndrome, which is a deficiency of internal factors or receptors in the intestines.
• Errors in the absorption of folate that are passed down in infants.

Triggers

What factors increase my risk of developing this condition?

One of the things that causes megaloblastic anemia is a deficiency of vitamin B12 and folic acid. In addition, there are several factors that make you more at risk of developing megaloblastic anemia, namely:

1. Lack of eating foods high in vitamin B12

Vitamin B12 deficiency can cause the spinal cord to not produce healthy blood cells. People who rarely eat red meat, chicken, fish, eggs, and milk, or vegetarians, are at risk of developing megaloblastic anemia.

2. Lack of folate intake

Lack of eating green vegetables such as spinach or mustard greens, or animal food products can cause the body to develop folate deficiency. Improper cooking methods, such as boiling vegetables for too long on a fire that is too hot can damage the folate content.

3. Impaired absorption of nutrients

Impaired absorption can make you deficient in nutrients even after eating foods containing vitamin B12 and folate and cause megaloblastic anemia. This is because your body can't absorb vitamins properly.

Usually this condition can be caused due to reduced protein in the stomach which helps the absorption of vitamin B12. Autoimmune conditions, bacterial infections, and parasitic worm infections will also make vitamin B12 levels more difficult to absorb. More specifically, megaloblastic anemia due to vitamin B12 deficiency is known as pernicious anemia.

Meanwhile, folic acid can tend to be more difficult for the body to absorb due to certain factors. For example, because you have a history of drinking excess alcohol, or are pregnant.

4. Medical conditions

There are several other medical conditions that can trigger megaloblastic anemia. Including the following:

• Leukemia
• HIV infection
• Myelodysplasia syndrome
• Myelofibrosis
• Use of epileptic anti-seizure drugs
• Use of chemotherapy drugs

Diagnosis

How to diagnose this condition?

Symptoms of anemia can reduce the quality of life and health of the sufferer over time. Therefore, anemia should not be allowed and need to be treated immediately.

There are various ways to diagnose all types of anemia. Here's how doctors check for and diagnose megaloblastic anemia:

1. Complete blood test (complete blood count)

A complete blood test can be used to diagnose many types of anemia. This test will measure the various components and the amount of your blood.

In addition, your doctor can check the number and appearance of your red blood cells. Blood cells that appear larger and less developed can be a sign that you have megaloblastic anemia.

Your doctor will also take your medical history and perform a physical exam to rule out other causes of your symptoms.

2. Test vitamin levels

Your doctor will need to do more blood tests to determine what's causing your anemia.

This additional blood test will also help your doctor find out if your anemia is due to vitamin B12 or folate deficiency.

3. Schilling test

The Schilling test is a blood test that evaluates your ability to absorb vitamin B-12. First it is recommended that you take a radioactive vitamin B12 supplement. You will then be asked to collect a urine sample for analysis.

You will again be asked to take the same radioactive supplement, combined with "intrinsic factor" protein. This factor is needed by your body to be able to absorb vitamin B-12.

The doctor will again ask for a sample of your urine to compare with the first sample.

If your urine does not contain intrinsic factor, this indicates that your body only absorbs B12 when consumed with intrinsic factor protein. This means that your body cannot absorb vitamin B12 naturally.

Treatment

How to treat megaloblastic anemia?

Knowing the symptoms and the types of causes can make it easier for you to get the right anemia treatment.

The goals of megaloblastic anemia treatment are to prevent the symptoms from getting worse, avoid complications due to anemia, as well as overcome the most basic causes, namely deficiency of vitamin b12 and folic acid.

Some of the possible treatment options for megaloblastic anemia include:

1. Increase your intake of vitamin B-12

In the case of megaloblastic anemia caused by a vitamin B-12 deficiency, you may need monthly vitamin B-12 injections. Based on the doctor's consideration as well as your anemia condition, injections can be given for up to a year.

In addition, you may also need to take vitamin B-12 supplements at the dosage prescribed by your doctor.

You can also eat more foods containing vitamin B-12 in your daily menu, such as:

• Egg
• Chicken
• Vitamin B12 fortified cereals
• Red meat (especially beef)
• Milk
• Shellfish

Some people have a genetic mutation in the MTHFR gene (methylenetetrahydrofolate reductase). This gene is responsible for processing certain B vitamins, including B12 and folate, into usable forms in the body.

People who have the MTHFR gene mutation are encouraged to take additional methylcobalamin supplements to prevent anemia from getting worse.

2. Adding folate intake

Megaloblastic anemia due to a lack of folate can be treated by regularly taking folic acid supplements or getting infusion of folate fluids.

Foods high in folate can also help prevent anemia from getting worse. Here are some foods that are good to eat to treat megaloblastic anemia due to folate deficiency:

• Orange fruit
• Dark green leafy vegetables
• Nuts
• Whole grains

Similar to vitamin B12 deficiency, people who have the MTHFR gene mutation are encouraged to use it methylfolate addition to preventing folate deficiency and its risks.

Prevention

How to prevent and treat megaloblastic anemia at home?

You can take several measures to prevent anemia or prevent symptoms from recurring. People with megaloblastic anemia due to vitamin B12 or folate deficiency can manage their symptoms and feel better with the following ongoing treatments:

• Eat lots of iron-rich foods, such as tofu, leafy greens, lean red meat, lentils, nuts, fortified cereals and breads.
• Eat and drink foods and drinks rich in vitamin C.
• Avoid drinking tea or coffee with meals as they can affect the absorption of iron and other vitamins
• Get enough vitamin B12 and folic acid in your diet.

Lack of vitamin B12 and folate can not only cause anemia, but also health problems, such as nerve damage, neurological problems, and digestive tract problems. These complications can be avoided if you are diagnosed and treated early.

Genetic testing can also be done to detect possible mutations of the MTHFR gene. This can be done as an initial step in early detection of megaloblastic anemia.

Talk to your doctor if you see signs of anemia so you and your doctor can come up with a treatment plan and help prevent permanent damage.