Anaemia, Megaloblastic
Description Diagnostic Criteria General and supportive measures Medicine treatment Referral ICD-10 code: D53.1 DESCRIPTION Anaemia caused by a deficiency of folate and/or vitamin B 12 . DIAGNOSTIC CRITERIA Clinical Pallor and fatigue. History of chronic diarrhoea. Investigations Megaloblastic anaemia: elevated MCV (mean corpuscular volume) and MCH (mean corpuscular haemoglobin). Macro-ovalo
Description
Diagnostic Criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: D53.1
DESCRIPTION
Anaemia caused by a deficiency of folate and/or vitamin B12.
DIAGNOSTIC CRITERIA
Clinical
- Pallor and fatigue.
- History of chronic diarrhoea.
Investigations
- Megaloblastic anaemia: elevated MCV (mean corpuscular volume) and MCH (mean corpuscular haemoglobin).
- Macro-ovalocytes on blood smear, hypersegmentation of neutrophils.
- Decreased serum vitamin B12 or red blood cell folate.
- Investigations to identify the reason for folate or vitamin B12 deficiency, e.g. malabsorption.
- Pancytopenia in severe cases.
- Actively exclude leukaemia and aplastic anaemia, which may cause macrocytosis.
GENERAL AND SUPPORTIVE MEASURES
- Dietary modifications to ensure adequate intake of folate and vitamin B12.
- Packed red blood cell transfusion for symptomatic anaemia. Try to avoid blood transfusion until all investigations have been done.
MEDICINE TREATMENT
Folic acid deficiency:
- Folic acid, oral, 5 mg daily until haemoglobin returns to normal value for age. Prolonged treatment may be needed for malabsorption states and congenital deficiencies.
Vitamin B12 deficiency:
- Vitamin B12, IM, 100 µg monthly. Should be given together with folate to prevent developmental of subacute combined degeneration of the spinal cord. Prolonged treatment may be needed.
REFERRAL
- All cases of megaloblastic anaemia, except clear nutritional folate deficiency.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital_2023 edition_Updated February 2025
Chapter 3: Blood and Blood-Forming Organs, 3.3 Anaemia, Megaloblastic