Finding the right diagnosis begins by collecting anamnesis and listening to the patient’s complaints. An experienced doctor can already suspect anemia at this stage.
The examination of the patient includes the following steps:
Examination of the skin: they are pale, sometimes with a yellowish tinge (“parchment skin”).
The language is red and shiny, painful and slightly swollen.
When listening to the heart beat, systolic noises and tachycardia are diagnosed.
During the probing of the peritoneum, the enlarged spleen is palpable.
There are also signs of funicular myelosis.
The next step in the diagnosis is the delivery of blood for clinical analysis. In the results of the study, a decrease in the number of erythrocytes and hemoglobin will be found, the color index of blood exceeds the 1.1 mark. Sometimes anemia is accompanied by thrombopenia and leukopenia. Macrocytes and megaloblasts are also visualized in the blood. Blood cells change their normal shape and size. Another sign of megaloblastic anemia is the presence of Kebbot rings and Jolly’s bodies in the blood. The level of reticulocytes is lowered.
There is also a deficiency of folic acid and vitamin B12 in the serum portion of the blood. The parameters of serum iron remain within normal limits, or increase, which is caused by accelerated destruction of red blood cells. This fact also provokes a jump in bilirubin in the blood.
The study of bone marrow, which is extracted by performing a sternal puncture, allows you to refine the diagnosis. The study should be carried out in advance, that is, before the beginning of treatment. The fact is that taking vitamin B12 within 1-2 days will return the bone marrow composition to normal, and signs of megaloblastic anemia will be stopped.
The overwhelming majority of patients are diagnosed with mucosal lesions of the digestive system with their atrophic changes. The production of hydrochloric acid decreases in the stomach.
Thus, the diagnosis of megaloblastic anemia consists of 3 main stages:
Blood sampling for general analysis.
Perform bone marrow puncture. Collection of anamnesis and study of the state of the organs of the digestive system, including liver, spleen, etc.
To exclude the fact of presence at the patient of parasitic invasion.
How to treat? / h2
Treatment should be based on the causes that led to the development of anemia. It may be necessary to take antiparasitic drugs, eliminate polyps or other neoplasms of the digestive system, treat intestinal diseases, place the patient in a narcological clinic, if he suffers from alcohol dependence, etc.
You must correct the patient’s diet. In his menu, you must enter meat, liver, dairy products, fresh vegetables and fruits.
To eliminate the deficiency of vitamin B12, intramuscular or intravenous administration of cyanocobalamin is possible. A day can be prescribed from 200 to 1000 μg of the drug, which depends on the severity of the anemia.
After the blood counts return to normal, the dosage of the drug can be reduced, or the number of injections is reduced. That is, inject the drug 1 time in 2 days, and then 2 times in 7 days.
Improvement occurs after a week from the start of treatment, which is characterized by the development of the reticulocytic crisis. In blood, the level of young erythrocytes increases by 2-3%. The effectiveness of the therapy is indicated by the normalization of blood counts.
Sometimes, the intake of vitamin B12 is prescribed for the rest of your life, for example, with Addison-Birmer anemia. With funicular myelosis, it is required to inject from 800 to 100 mg of cyanocobalamin daily to the patient. Reduce the dosage of the drug can only be after you can completely rid the patient of neurologic symptoms.
Sometimes megaloblastic anemia is very difficult, and the patient himself can fall into a coma. In this case, he needs a transfusion of erythrocyte mass.
When the main for the development of anemia are autoimmune diseases, the patient requires the introduction of glucocorticosteroids. Dosage of the drug should be minimal, and the course of treatment is short.
Folic acid is prescribed for folic acid deficiency anemia. The daily dose is from 1 to 5 mg of the drug, depending on the severity of the disease. After all the symptoms of anemia have been stopped, you will need a course of folic acid to prevent the recurrence of the disease. But the dose of the drug should be reduced.
h2 Prophylaxis and forecast
To prevent development of anemia, the following recommendations should be observed:
It is right to eat by eating foods rich in vitamin B9 and B12.
Maintain a healthy lifestyle, give up alcoholism.
Do not allow situations that could lead to infection by parasites.
Time to treat all diseases of the digestive system
As for the prognosis, with timely therapy, it is favorable and anemia can completely get rid of.
Which doctor treats megaloblastic anemia?
If the first signs of anemia appear, you should consult your local therapist. If the doctor reveals such a violation, he will redirect the patient to a hematologist who will prescribe the treatment. Consultation with narrow specialists is possible, among them: neurologist, infectious disease specialist, hepatologist, gastroenterologist. To select an adequate diet, you should visit a nutritionist.