How are megaloblastic anemias treated?

Treatment of acquired forms of megaloblastic anemia

_{It is essential to eliminate the cause of vitamin B12} or folic acid deficiency (poor feeding, helminthic infestation, medication intake, infections, etc.).

For vitamin B₁₂ deficiency

In case of vitamin B12 deficiency, _its preparations are prescribed - cyanocobalamin or oxycobalamin. The therapeutic dose (saturation dose) is 5 mcg/kg/day for children under one year; 100-200 mcg per day - after one year, 200-400 mcg per day - in adolescence. The drug is administered intramuscularly once a day for 5-10 days until a regiculocytic crisis occurs, and then every other day - until hematological remission is achieved. The duration of the course is 2-4 weeks. In the presence of neurological manifestations, the vitamin is administered at a dose of 1000 mcg per day intramuscularly for at least 2 weeks.

Treatment effectiveness criteria

1. Reticulocyte crisis (increase in the number of reticulocytes from the 3rd-4th day; maximum increase in the number of reticulocytes on the 6th-10th day of treatment; normalization of the number of reticulocytes by the 20th day; the degree of reticulocytosis is proportional to the degree of anemia).
2. Normalization of bone marrow hematopoiesis (by the 4th day of treatment).
3. Normalization of the peripheral blood picture (improvement in red blood counts is noted from the end of the first week of therapy).
4. Reduction of neurological symptoms from the 3rd day of treatment; complete normalization after several months.

The therapy is consolidated by administering the drug in a daily dose once a week for two months, then twice a month for six months and once every six months for several years.

If the cause of B ₁₂ -deficiency anemia is eliminated, there is no need for further therapy. If the cause of anemia persists or is not completely eliminated, maintenance therapy is carried out annually with preventive courses of vitamin B ₁₂ in a daily dose every other day for 3 weeks. Interruption of therapy after 10-18 months will lead to a relapse of anemia, an early sign of which is hypersegmentation of neutrophil nuclei.

In the presence of isolated vitamin B12 deficiency _, the administration of folic acid is inappropriate, since it has no effect on neurological symptoms and can even accelerate their development.

Iron and folic acid deficiency may develop against the background of cobalamin treatment, since they are consumed by proliferating tissues. In this regard, vitamin B ₁₂ can be supplemented with folic acid 7-10 days after the start of treatment; iron preparations are prescribed after the CI has decreased to 0.8. If the patient has polydeficiency anemia (for example, iron-vitamin B ₁₂ deficiency anemia in a vegetarian, a patient with the "cecum" syndrome, etc.), therapy begins with the prescription of an iron preparation, and vitamin B ₁₂ is added from the 3rd-4th week of treatment and later. In severe anemia, correction of vitamin B ₁₂ deficiency can lead to acute hypokalemia, hypophosphatemia, and hyperuricemia due to the sharp activation of cell proliferation and DNA and protein metabolism.

Blood transfusions are used only in cases of hemodynamic disorders and coma.

Folic acid deficiency

In case of folic acid deficiency, 1-5 mg of folic acid is prescribed orally daily for 3-4 weeks or several months, i.e. until a new population of red blood cells is formed. The dose of folic acid for children in the first year of life is 0.25-0.5 mg/day. In the presence of malabsorption syndrome, the dose is 5-15 mg/day.

The number of reticulocytes begins to increase on the 2nd-4th day of treatment, the maximum increase is noted on the 4th-7th day of therapy. Normalization of the hemoglobin level occurs on the 2nd-6th week. The number of leukocytes and thrombocytes increases in parallel with reticulocytosis. Normalization of bone marrow hematopoiesis occurs within 24-48 hours, but giant myelocytes and metamyelocytes can be observed for several days.

Prevention of megaloblastic anemia

Rational nutrition is a diet with mandatory consumption of meat, milk, liver, cheese, vegetables (tomatoes, lettuce, spinach, asparagus).

Prescription of folic acid in a dose of 5-10 mg/day in the last trimester of pregnancy, 1-5 mg per day for premature babies and children with malabsorption syndrome in courses of 14 days.

Outpatient observation during the period of remission

• Examination by a hematologist once a month during the first 6 months of observation; then once every 3 months for 1.5 years; the total observation period for acquired forms is at least 2 years.
• Clinical blood test with determination of the number of reticulocytes before each examination by a hematologist.

Maintenance therapy courses of vitamin B12 ₍ according to the scheme).

Diet correction.

Continuation of therapy for the underlying disease that led to the development of megaloblastic anemia.

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