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  Megablastic Anemia

  (Vitamin B –12 Deficiency – Pernicious Anemia)     




Problem: S/O evidence


Recommended Therapy

Goals/Monitoring Parameters

Patient Education



-Sore Tongue

-Peripheral neuropathy

-Neurologic symptoms (tinnitus, neuritis, vertigo, and HA)   


-Serum vit. B12 ß

-MCV (macrocytic) Ý

-MCHC (homochromic/ normochrmic) ß Û

-Reticulocytes ß

-RDW (variation) Ý

-Hgb and Hct ß


Schilling’s Test-evaluates Vit B12 absorption.  < 5% (+) for P. anemia. [Normal 15-50%)



*1).Inability to absorb Vit B12 (at the distal ileum)

-Reduced intrinisic factor

-Reduced acid secretion/H2-receptor blockers

-Occurs freq. In pts with:


--Hashimoto’s thyroiditis


--Rheumatoid Arthritis

--Gastric cancer  


2).B12 Deficiency:

-Inadequate intake of B12

-Decreased absorption, transport,utilization

--inherited atrophic gastropathy

--Reduced intrinisic factor

--gastrectomy (ilialsectomy)

--Pancreatic insufficiency

--Bacterial overgrowth in the intestine

--Transcobalamin deficiency

Vit. B12- important for hematopoiesis, maintanence of myelin throughout CNS, production of epithelial cells.    

Minimum Daily Requirement: 1-5 mcg/day vit. B-12 

Daily lost:  1mcg/d  

Deficiency Symptoms develop: 3-4 yearsàBody storage: 2000-5000 mcg and enterohepatic recirculation    


IM:  Vitamin B12 (Cyanocobalamin)

100mcg IM QD x 2 weeks then 100mcg IM Qmonth indefinitely


PO:  Available for Pt w/ contraindication to Parenteral but requires HIGH doses (500-1000mcg) not recommended due to lack of compliance and efficacy.    

IF D/C, reoccurance in 5 yrs


Correct underlying cause

Restore B12 levels

Relieve Symptoms

Restore Hgb, Hct



PO/IV Therapy Response—

-Neurologic: Symptoms-improve within 24 hrs

-Reticulocytes – normal by 5 days

-Hct—normalized in 1-2months

-Bone marrow-normoblastic w/in 48h

-Hematologic parameters improvement in few days  

**Monitor CBC q3-6months to evaluate efficacy

Regular Healthy Diet (meat and dairy)




Di Piro JT, et al.  Pharmacotherapy, A Pathophysiologic Approach. 4th edition. Stamford, Appleton & Lange, Inc, 1999.L.Y. Young and M.A. Koda Kimble (eds):  Applied Therapeutics:  The Clinical Use of Drugs. 6th edition. Vancouver, Applied Therapeutics, Inc.,1995.Teresi ME, Kailis SG, Berbatis CG.  Iron deficiency and Megaloblastic anemias.  In:  Textbook of Therapeutics. 6th Edition.