What is megaloblastic anemia?

Megaloblastic anemia is a type of anemia characterized by very large red blood cells. In addition to the cells being large, the inner contents of each cell are not completely developed. This malformation causes the bone marrow to produce fewer cells, and sometimes the cells die earlier than the 120-day life expectancy. Instead of being round or disc-shaped, the red blood cells can be oval.

Causes

There are many causes of megaloblastic anemia, but the most common source in children occurs from a vitamin deficiency of folic acid or vitamin B-12. Other sources of megaloblastic anemia include the following:

• Digestive diseases — Certain diseases of the lower digestive tract can lead to megaloblastic anemia. These include celiac disease, chronic infectious enteritis, and enteroenteric fistulas. Pernicious anemia is a type of megaloblastic anemia caused by an inability to absorb Vitamin B-12 due to a lack of intrinsic factor in gastric (stomach) secretions. Intrinsic factor enables the absorption of Vitamin B-12.
• Malabsorption — Inherited congenital folate malabsorption, a genetic problem in which infants cannot absorb folic acid in their intestines, can lead to megaloblastic anemia. This requires early intensive treatment to prevent long-term problems such as intellectual disabilities.
• Medication-induced folic acid deficiency — Certain medications, specifically ones that prevent seizures, such as phenytoin, primidone and phenobarbital, can impair the absorption of folic acid. The deficiency can usually be treated with a dietary supplement.
• Folic acid deficiency — Folic acid is a B vitamin required for the production of normal red blood cells. Folic acid is present in foods such as green vegetables, liver and yeast. It is also produced synthetically and added to many food items.

Signs and symptoms

Children with megaloblastic anemia may experience different symptoms and symptoms may vary in severity. Some of the most common symptoms of megaloblastic anemia include: 

• Abnormal paleness or lack of color of the skin
• Decreased appetite
• Irritability
• Lack of energy or tiring easily (fatigue)
• Diarrhea
• Difficulty walking
• Numbness or tingling in hands and feet
• Smooth and tender tongue
• Weak muscles

The symptoms of megaloblastic anemia may resemble other blood conditions or medical problems. Always consult your child's physician for a diagnosis.