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{{Macrocytic anemia}}
{{Macrocytic anemia}}
{{CMG}}
{{CMG}}; {{AE}} {{ADS}}{{OK}}
==Overview==
==Overview==
The common causes of megaloblastic anemia are less dietray intake, autoimmune disorders like [[pernicious anemia]], [[alcoholism]], increased demands like in [[pregnancy]] and due to drugs.
==Causes==
==Causes==
Normal B12 absorption and action are dependent of 5 things: dietary intake, acid in the stomach, pancreatic secretions, secretion of IF by Gastric parietal cells, an ileum that can absorb the IF-B12 complex
* Vitamin B12 Deficiency: <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>


#Deficient intake
===Common Causes===
#Deficient intrinsic factor ([[pernicious anaemia]] or [[gastrectomy]])
Common causes of macrocytic anemia may include: causes of megaloblastic anemia and non megaloblastic anemia:<ref name="pmid10875288">{{cite journal |vauthors=Savage DG, Ogundipe A, Allen RH, Stabler SP, Lindenbaum J |title=Etiology and diagnostic evaluation of macrocytosis |journal=Am. J. Med. Sci. |volume=319 |issue=6 |pages=343–52 |date=June 2000 |pmid=10875288 |doi= |url=}}</ref><ref name="pmid29264027">{{cite journal |vauthors=Nagao T, Hirokawa M |title=Diagnosis and treatment of macrocytic anemias in adults |journal=J Gen Fam Med |volume=18 |issue=5 |pages=200–204 |date=October 2017 |pmid=29264027 |pmc=5689413 |doi=10.1002/jgf2.31 |url=}}</ref><ref name="pmid108752882">{{cite journal |vauthors=Savage DG, Ogundipe A, Allen RH, Stabler SP, Lindenbaum J |title=Etiology and diagnostic evaluation of macrocytosis |journal=Am. J. Med. Sci. |volume=319 |issue=6 |pages=343–52 |date=June 2000 |pmid=10875288 |doi= |url=}}</ref>
#Bilogical competition for B12 by [[diverticulosis]], [[fistula]], intestinal [[anastomosis]], [[achlorhydria]] and infection by the marine parasite ''Diphyllobothrium latum''
#Selective B12 malabsorption (congenital and drug-induced)
#Chronic [[pancreatitis]]
#Ileal resection and bypass


==== Megaloblastic ====
* Vitamin B12 Deficiency:  
*# Deficient intake
*# Deficient intrinsic factor ([[pernicious anaemia]] or [[gastrectomy]])
*# Bilogical competition for B12 by [[diverticulosis]], [[fistula]], intestinal [[anastomosis]], [[achlorhydria]] and infection by the marine parasite ''Diphyllobothrium latum''
*# Selective B12 malabsorption (congenital and drug-induced)
*# Chronic [[pancreatitis]]
*# Ileal resection and bypass
* Folate Deficiency:
* Folate Deficiency:
#Deficient intake.
*# Deficient intake
#Increased needs: [[pregnancy]], [[infant]], rapid cellular proliferation, and [[cirrhosis]]
*# [[Alcoholism]]
#Malabsorption (congenital and drug-induced)
*# Increased needs: [[pregnancy]], [[infant]], rapid cellular proliferation, and [[cirrhosis]]
#Intestinal and jejunal resection
*# Malabsorption (congenital and drug-induced)
*# Intestinal and jejunal resection  
* Toxins and Drugs:
** [[Amobarbital sodium]]
** [[Cycloserine]]
** [[Cytarabine]]
** [[Ethotoin]]
** [[Folic acid]] antagonists ([[methotrexate]])
** [[Pergolide]]
** [[Purine]] antagonists ([[6-mercaptopurine]])
** [[Pyrimidine]] antagonists (cytosine arabinoside)
** [[Phenobarbital]]
** [[Pyrimethamine]]
** [[Secobarbital sodium]]
** [[Trimethoprim]]
** [[Erythroleukemia]].


* Combined Dieficiency (Tropical Sprue): Vitamin B12 & Folate.
==== Non megaloblastic ====
* [[Myelodysplasia]]
* [[Chronic liver disease]]
* [[Reticulocytosis]]
* [[Hypothyroidism]]
 
===Less Common Causes===
Less common causes of macrocytsic anemia include: <ref name="pmid9930566">{{cite journal |vauthors=Rosenblatt DS, Whitehead VM |title=Cobalamin and folate deficiency: acquired and hereditary disorders in children |journal=Semin. Hematol. |volume=36 |issue=1 |pages=19–34 |date=January 1999 |pmid=9930566 |doi= |url=}}</ref>
* Combined deficiency(vitamin B12 & folate) [[Tropical sprue]]
* Inherited [[DNA]] Synthesis Disorders: Deficient [[thiamine]] and factors (e.g. enzymes) responsible for folate metabolism.
* Inherited [[DNA]] Synthesis Disorders: Deficient [[thiamine]] and factors (e.g. enzymes) responsible for folate metabolism.
* Toxins and Drugs:
* [[Lesch-Nyhan Syndrome]]
#[[Folic acid]] antagonists ([[methotrexate]])
* [[Methylmalonic aciduria]]
#[[Purine]] antagonists ([[6-mercaptopurine]])
* [[Orotic aciduria]]
#[[Pyrimidine]] antagonists (cytosine arabinoside)
 
* [[Erythroleukemia]].
===Genetic Causes===
* [[Lesch-Nyhan Syndrome]]
* [[Orotic aciduria]]
**
 
===Causes by Organ System===
 
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes
|-
| bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Dental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| bgcolor="Beige" |[[Amobarbital sodium]], [[Cycloserine]], [[Cytarabine]], [[Ethotoin]], [[Folic acid]] antagonists ([[methotrexate]]), [[Pergolide]], [[Purine]] antagonists ([[6-mercaptopurine]]), [[Pyrimidine]] antagonists (cytosine arabinoside), [[Phenobarbital]], [[Pyrimethamine]], [[Secobarbital sodium]], [[Trimethoprim]]
|-
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" | [[Hypothyroidism]]
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| bgcolor="Beige" | [[Chronic liver disease|Chronic liver diseases]], [[diverticulosis]], [[fistula]], intestinal [[anastomosis]], [[achlorhydria]]
|-
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| bgcolor="Beige" |[[Lesch-Nyhan Syndrome]], [[Methylmalonic aciduria|Methylmalonic aciduria,]] [[Orotic aciduria]]
|-
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" | [[Myelodysplasia]], [[Pernicious anemia]], [[Reticulocytosis]]
|-
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" | ''[[Diphyllobothrium latum]]''
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| bgcolor="Beige" | [[Alcoholism]], [[Folate deficiency]],[[Orotic aciduria]],  [[Vitamin B12]] deficiency
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | [[Pregnancy]]
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" | No underlying causes
|-
|}


*In general:
===Causes in Alphabetical Order===
:* Nutritional defects (folic acid or vitamin B12 which is mainly from animal sources; [[vegan]]s may require supplementation)
List the causes of the disease in alphabetical order:
:* Chronic liver diseases
<div style="-moz-column-count:3; column-count:3;">
:* Alcoholism
* [[Achlorhydria]]
:* Pregnancy
* [[Alcoholism]]
:* Decreased production of [[intrinsic factor]] (this disease entity is called [[pernicious anemia]])
* [[Amobarbital sodium]]
:* Intestinal [[malabsorption]] (due to an enteritis, [[celiac disease]] or other causes).
* [[Amobarbital sodium|Chronic liver diseases]]
:* Fish tapeworm infestation ([[Diphyllobothrium]] latum)
* [[Cycloserine]]
:* Failure to replicate [[chromosomes]] due to lack of [[thymidine]].
* [[Cytarabine]]
:* [[Lesch-Nyhan Syndrome]]
* ''[[Diphyllobothrium latum]]''
:* Cytotoxic drugs interfering with DNA synthesis
* [[Diverticulosis]]
:* [[Gut flora|intestinal flora]] disruption due to antibiotic use
* [[Ethotoin]]
* [[Fistula]]
* [[Folate deficiency]]
* [[Folic acid]] antagonists ([[methotrexate]])
* [[Hypothyroidism]]
* [[Lesch-Nyhan Syndrome]]
* [[Methylmalonic aciduria]]
* [[Myelodysplasia]]
* [[Orotic aciduria]]
* [[Pergolide]]
* [[Pernicious anemia]]
* [[Purine]] antagonists ([[6-mercaptopurine]])
* [[Pyrimidine]] antagonists (cytosine arabinoside)
* [[Phenobarbital]]
* [[Pregnancy]]
* [[Pyrimethamine]]  
* [[Reticulocytosis]]  
* [[Secobarbital sodium]]  
* [[Trimethoprim]]
* [[Vitamin B12]] deficiency
</div>


==References==
==References==

Latest revision as of 13:34, 19 October 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2] Omer Kamal, M.D.[3]

Overview

The common causes of megaloblastic anemia are less dietray intake, autoimmune disorders like pernicious anemia, alcoholism, increased demands like in pregnancy and due to drugs.

Causes

Common Causes

Common causes of macrocytic anemia may include: causes of megaloblastic anemia and non megaloblastic anemia:[1][2][3]

Megaloblastic

Non megaloblastic

Less Common Causes

Less common causes of macrocytsic anemia include: [4]

Genetic Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Amobarbital sodium, Cycloserine, Cytarabine, Ethotoin, Folic acid antagonists (methotrexate), Pergolide, Purine antagonists (6-mercaptopurine), Pyrimidine antagonists (cytosine arabinoside), Phenobarbital, Pyrimethamine, Secobarbital sodium, Trimethoprim
Ear Nose Throat No underlying causes
Endocrine Hypothyroidism
Environmental No underlying causes
Gastroenterologic Chronic liver diseases, diverticulosis, fistula, intestinal anastomosis, achlorhydria
Genetic Lesch-Nyhan Syndrome, Methylmalonic aciduria, Orotic aciduria
Hematologic Myelodysplasia, Pernicious anemia, Reticulocytosis
Iatrogenic No underlying causes
Infectious Disease Diphyllobothrium latum
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic Alcoholism, Folate deficiency,Orotic aciduria, Vitamin B12 deficiency
Obstetric/Gynecologic Pregnancy
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

List the causes of the disease in alphabetical order:

References

  1. ↑ Savage DG, Ogundipe A, Allen RH, Stabler SP, Lindenbaum J (June 2000). "Etiology and diagnostic evaluation of macrocytosis". Am. J. Med. Sci. 319 (6): 343–52. PMID 10875288.
  2. ↑ Nagao T, Hirokawa M (October 2017). "Diagnosis and treatment of macrocytic anemias in adults". J Gen Fam Med. 18 (5): 200–204. doi:10.1002/jgf2.31. PMC 5689413. PMID 29264027.
  3. ↑ Savage DG, Ogundipe A, Allen RH, Stabler SP, Lindenbaum J (June 2000). "Etiology and diagnostic evaluation of macrocytosis". Am. J. Med. Sci. 319 (6): 343–52. PMID 10875288.
  4. ↑ Rosenblatt DS, Whitehead VM (January 1999). "Cobalamin and folate deficiency: acquired and hereditary disorders in children". Semin. Hematol. 36 (1): 19–34. PMID 9930566.

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