This disease is a form of macrocytic anemia (a blood disorder) that occurs when the bone marrow produces stem cells that make large red blood cells. It is called megaloblastic anemia, and it is a part of vitamin deficiency anemia that occurs when the body does not get enough vitamin B12 and vitamin B9 (folate). Most of the time, doctors treat megaloblastic anemia with supplements.
Normally, the body needs a certain amount of healthy red blood cells to carry oxygen to all body organs and tissues. These cells are produced as stem cells in the bone marrow, like all blood cells. Moreover, vitamins B12 and B9 help form red blood cells, and if you do not have enough vitamins, the body begins to produce abnormal cells called megaloblasts.
In addition, these abnormal blood cells do not divide and reproduce as healthy cells do, which means there is a reduced amount of red blood cells in the bone marrow. Furthermore, these cells are unusually large as they cannot get out of the bone marrow to move into the bloodstream.
Usually, this condition occurs rarely, and it is quite difficult to estimate how many people experience it.
Symptoms
Usually, people with megaloblastic anemia experience symptoms similar to those of other types of anemia. These include:
- Weakness
- Pallor (the skin is more pale than usual)
- Fatigue (extreme tiredness)
- Dyspnea (shortness of breath)
- Lightheadedness
- Tingling sensations
- Loss of sensations
- Muscle weakness
Do not hesitate to visit a doctor if any of the previous symptoms occur. Otherwise, it may lead to serious complications.
Causes
People often develop megaloblastic anemia when they do not get enough vitamin B12 or vitamin B9. These vitamins are very important for bone marrow development and the production of healthy red blood cells that carry oxygen-rich blood throughout the body.
Vitamin B12 Deficiency Causes
While some people may develop a vitamin B12 deficiency due to a poor diet, others may experience it due to certain health conditions that negatively affect the body’s ability to absorb nutrients. These include:
- Pernicious anemia – This is an autoimmune disorder that affects the body’s ability to absorb vitamin B12.
- Gastrectomy – This is a surgical procedure used to remove a part of the stomach. It may also affect vitamin B12 absorption.
- Zollinger-Ellison syndrome – This is a serious health condition that may cause multiple health problems, including vitamin B12 deficiency.
- Blind loop syndrome – This condition occurs when the food you have digested stops moving through the intestines. As a result, the bacteria begin to grow using up vitamin B12.
- Fish tapeworm infestation – People who get a tapeworm infection by eating undercooked infected fish may also develop a vitamin B12 deficiency because these worms feed on vitamin B12.
- Pancreatic insufficiency – This is a serious condition in which the pancreas is not able to produce digestive enzymes to break down food. Thus, you may not get enough nutrients from your diet.
Vitamin B9 Deficiency Causes
Mostly, people develop vitamin B9 deficiency due to a poor diet that does not include green vegetables, fruits, meat, or foods enriched with folic acid. However, it may also occur due to other causes. These include:
- Digestive system diseases – In such cases, the body is not able to absorb enough folic acid, especially if you have celiac disease or Crohn’s disease.
- Misuse of alcoholic drinks – People who drink large amounts of alcoholic beverages also do not get enough vitamin B9.
- Overcooking fruits and vegetables – Vitamin B9 can be destroyed when you overcook fruits or vegetables.
- Hemolytic anemia – This is a blood disorder in which red blood cells are broken down, and the bone marrow is not able to replace them quickly enough.
- Medicines – There are some ulcerative colitis medicines and antiseizure drugs that affect the body’s ability to absorb folic acid.
- Dialysis – If you have kidney problems and receive dialysis, it may affect the amount of vitamin B9 that remains in the body.
Complications
Sometimes, people with vitamin B12 or B9 deficiency may experience some complications, especially if they develop a severe vitamin deficiency or do not get treatment. Check some examples below:
- Subacute combined degeneration – This complication causes permanent nerve damage, which may lead to ataxia, peripheral neuropathy, and loss of balance.
- Cognitive impairment – For example, dementia, confusion, and memory loss.
- Psychiatric problems – Some people may experience sleep disturbances (insomnia), panic attacks, irritability, depression, and others.
- Optic nerve atrophy (vision loss)
- Heart failure
- Severe anemia that often causes extreme tiredness, weakness, and lightheadedness.
- Intramedullary hemolysis
- Gastrointestinal issues – For example, unusual weight loss, diarrhea, or a painful tongue.
- Hypokalemia – A severe drop in Potassium levels.
- An increased risk for certain cancers (such as gastric cancer)
This document does not contain a complete list of complications. In any case, you can try to talk with your doctor about ways to reduce the risk of developing the previous complications.
How to Prevent Megaloblastic Anemia?
Healthcare professionals may recommend some tips to reduce the risk of vitamin B12 or B9 deficiency. For example:
- Dietary changes – You should eat a balanced diet that includes foods containing vitamin B12 and vitamin B9.
- Limit or avoid alcoholic drinks because they can prevent the body from absorbing vitamin B12.
- Manage disorders that affect the body’s ability to absorb nutrients.
Vitamin B12 Foods
These include:
- Animal food products – For example, red meat, fish, poultry, eggs, milk, and other dairy products.
- Fortified foods – These are specific foods that contain added vitamins and nutrients they normally do not have. Examples include certain breakfast cereals, nutritional yeast, plant milk, and some types of bread.
Vitamin B9 Foods
- Vegetables (including peas, beans, legumes, dark green leafy vegetables, and others)
- Fruits (including citrus fruits)
- Animal food products (such as liver, seafood, meat, and poultry)
- Eggs and dairy
- Fortified foods – You can always check the food label (nutritional facts) to confirm the foods you eat have vitamin B9. Examples include certain breads, flour, pasta, rice, and cereal that contain folic acid.
Diagnosis
Doctors often begin the diagnosis with a physical examination to check for abnormalities linked to the disease. However, to rule out other conditions that cause similar symptoms, doctors often perform the following tests. For example:
- Complete blood count (CBC) – This test is used to determine your red blood cell count and its function.
- Peripheral blood smear (PBS) – Doctors often perform this test to examine your blood cells.
- Reticulocyte count – During this test, doctors will measure the amount of immature red blood cells (reticulocytes) in the bone marrow.
Treatment
In most cases, megaloblastic anemia is treated with vitamin B12 and vitamin B9 supplements and dietary changes. For example:
- Vitamin B12 deficiency treatment – Doctors may recommend vitamin B12 injections for a few weeks to return its level to normal. However, if your body cannot absorb this vitamin, you may need these injections for the rest of your life.
- Vitamin B9 deficiency treatment – In most cases, doctors recommend folic acid tablets to treat vitamin B9 deficiency. In rare cases, vitamin B9 supplements may worsen the symptoms of megaloblastic anemia.
Frequently Asked Questions
Is megaloblastic anemia a serious illness?
This condition is often caused by a vitamin B12 or B9 deficiency. Without treatment, this condition may lead to serious neurological problems (such as memory loss), problems with balance, and paresthesia.
What can I expect if I have megaloblastic anemia?
While most people get better with vitamin supplements, some of them may need treatment for the rest of their lives. It happens because they have a condition that negatively affects the body’s ability to absorb nutrients. For more details, discuss it with your physician.
Can megaloblastic anemia be fatal?
In general, there is an increased risk of early and sudden death after treatment of this condition. However, the mortality rate is about 14% in people with a severe form of megaloblastic anemia. Ask your healthcare provider if you have any other questions.
