A few years ago, a taxi driver was seen. The patient was suddenly fainted after going to the toilet and was rushed to the hospital. At first, the doctor thought it was hypoglycemia or cerebrovascular disease. After a systematic examination, he found that it was not the case, so he suggested that he come to the blood department to see.
After I received the consultation, I learned more about the situation and learned that he usually had “unstable walking, tongue pain, numbness of hands and feet, loss of taste, and tiredness”, and it has been at least half a year. Moreover, this dedicated driver often finishes his performance more often every day, and his long-term diet is irregular. He usually only eats breakfast. See the anemia face when checking the body, the tongue is bright red and smooth, the taste is diminished, the skin of the hands and feet is numb, and the gait is unstable when walking, just like stepping on the spring bed.
Based on these circumstances, I arranged for him to take blood tests for blood routine, serum folic acid and vitamin B12. As a result of the test, the patient was diagnosed with “mega-cell anemia” caused by vitamin B12 deficiency.
Megaloblastic anemia is a common anemia disease caused by an abnormality in bone marrow and peripheral blood caused by cell deoxyribonucleic acid (DNA) synthesis disorders, mainly due to a deficiency of folic acid and/or vitamin B12. Both folic acid and vitamin B12 are important coenzymes in DNA synthesis.
Folic acid, also known as “pteroylglutamic acid”, is a water-soluble B vitamin and a key coenzyme for thymic nucleotide production, while thymus nucleotides are the most important part of the process of synthesizing DNA.
Humans cannot synthesize folic acid by themselves and must rely on folic acid in food. Normal people need about 200 ug of folic acid per day (300 ug to 400 ug for pregnant women and lactators). The total amount of folic acid in the human body is about 5 mg to 20 mg, which is only used for 4 months. When folic acid is deficient, thyroid nucleotide production is blocked, which in turn causes DNA synthesis disorders.
Vitamin B12 (VitB12), also known as cobalt ammonium, is also a water-soluble B vitamin. The predominant form in the human body is methylcobalt ammonium. Humans mainly obtain VitB12 through animal products such as liver, kidney, meat, fish, dairy products and the like. The daily requirement for adults is 1ug. VitB12 can participate in the synthesis of methionine and affect the amount of coenzyme in the synthesis of thymine nucleotides. Therefore, when VitB12 is deficient, it will also cause DNA synthesis disorders, resulting in megaloblastic anemia.
Absorption barrier is the most common cause
Folic acid and VitB12 deficiency mainly have the following aspects:
1. Reduced intake. Poor eating habits such as partial eclipse, poor diet, lack of fresh green vegetables, meat, eggs, etc., or cooking time at high temperatures, improper feeding of artificial infants, alcohol abuse, etc.
2. Absorption barriers. Mainly caused by a variety of gastrointestinal disorders, such as oral inflammatory diarrhea, celiac disease, short circuit formation of the small intestine or reduced absorption area after resection. Another example is drug interference absorption, such as antiepileptic drugs, sulfasalazine, ethanol, etc. can inhibit folic acid absorption. Absorption disorders are the most common cause of VitB12 deficiency. Gastric acid deficiency and decreased secretion of pepsin, atrophic gastritis, total gastrectomy, internal factor antibody, ileal resection, Crohn’s disease, invasive intestinal disease (tumor), drugs (such as neomycin, metformin, benzene) Bismuth, etc.) can affect the absorption of VitB12.
3. Use obstacles. Methotrexate, trimethoprim and other drugs, anesthetic drugs such as nitrous oxide can affect the utilization of VitB12.
4. The amount of demand increases. Special physiological periods such as pregnancy, breastfeeding, infants, adolescent growth period, etc., such as disease physiology such as hyperthyroidism, chronic hemolysis, etc., can cause an increase in folic acid requirements, so that the supply is relatively insufficient.
5. Damage increased. Large doses of vitamin C can destroy VitB12.
6. Excretion increases. Such as alcohol and so on.
Giant juvenile cell anemia has multiple manifestations
There are many manifestations of megaloblastic anemia, which mainly include four aspects:
1. The blood system is characterized by gradual anemia. Frequent feelings of fatigue, fatigue, dizziness, palpitations after work, shortness of breath, pale, fainting. In severe cases, thrombocytopenia may also occur, with skin purpura, nosebleeds, fundus hemorrhage, and menorrhagia.
2. Digestive tract manifests as tongue nipple atrophy,
”mirror tongue” or “beef tongue”, tongue pain, loss of appetite, nausea, vomiting, bloating, diarrhea, mushy or constipation.
3. Neuropsychiatric can be expressed as irritability, irritability, insomnia, forgetfulness, depression, confusion, moodiness, and even paranoia. The manifestation of the nervous system is mainly due to the lack of neurological damage in VitB12, bilateral sympathetic sensation (like wearing thick gloves or thick socks), loss of taste or sense of smell, weakness of limb muscles, unstable walking gait, decreased vision, etc. May cause disability when the nerve is severely damaged.
4. Other manifestations include decreased immunity and infection.
The megaloblastic anemia is often manifested as large cell anemia in blood, not only by reduced hemoglobin (HGB), but also by an increase in mean red blood cell volume (MCV) and mean red blood cell hemoglobin (MCH). When the condition is severe, white blood cell and platelet counts are also reduced. Serum folate or vitamin B12 levels are also reduced.
The patient in this article is due to a decrease in VitB12 intake due to long-term bad eating habits, resulting in a deficiency of VitB 12 in the body, which leads to megaloblastic anemia, which is characterized by anemia and neurological damage.
Prevention is the best policy
Usually, megaloblastic anemia is not difficult to diagnose, and the diagnosis of blood routine, serum folic acid and vitamin B12 can be confirmed. The treatment plan is not complicated. If it can be diagnosed and treated in time, the treatment effect will be immediate and the prognosis is also ideal.
By actively and rationally supplementing folic acid and VitB12, the symptoms of patients will be significantly improved within 1 day to 3 days. Continued treatment from January to February, patients with anemia can be completely corrected. It should be noted that the recovery of symptoms of the nervous system is slow, and it is often necessary to treat at least half a year. If it does not heal for a long time, it may be difficult to return.
Although megaloblastic anemia is effective, prevention is the best policy. Improve awareness of the disease, improve the quality of the diet, and pay attention to nutritional balance. For special populations, such as patients after ileal resection, oral inflammatory diarrhea, celiac disease, and vegetarians, the corresponding vitamin B12 or folic acid should be supplemented regularly to prevent the occurrence of megaloblastic anemia.