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Megaloblastic anemia is an anemia (of macrocytic classification) which results from inhibition of DNA synthesis in red blood cell production.[1] This is often due to deficiency of vitamin B12 and/or folic acid. Megaloblastic anemia not due to hypovitaminosis may be caused by antimetabolites which poison DNA production, such as some chemotherapeutic or antimicrobial agents (trimethoprim).
It is characterized by many large immature and dysfunctional red blood cells (megaloblasts) in the bone marrow,[2] and also by hypersegmented or multisegmented neutrophils.
The blood film can point towards vitamin deficiency:
Blood chemistries will also show:
Normal levels of both methylmalonic acid and total homocysteine rule out clinically significant cobalamin deficiency with virtual certainty. [3]
Bone marrow (not normally checked in a patient suspected of megaloblastic anemia) shows megaloblastic hyperplasia.
Subacute combined degeneration of spinal cord and its symptoms may be present due to demyelination, and deficiency of vitamin B-12
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