Nutritional Macrocytic Anemia Research Articles

Parenteral vs Oral Vitamin B12 in Children With Nutritional Macrocytic Anemia: A Randomized Controlled Trial

There is limited literature in children on efficacy of different routes of vitamin B12 administration for vitamin B12 deficiency macrocytic-megaloblastic anemia. To compare parenteral with oral vitamin B12 therapy in children with macrocytic-megaloblastic anemia. Single-center, open-label randomized controlled trial. 80 children aged 2 month-18 year with clinical and laboratory features of nutritional macrocytic anemia. All children received an initial single parenteral dose of 1000 µg vitamin B12 followed by randomization to either parenteral or oral vitamin B12 for subsequent doses. Group A was given 1000 µg intramuscular (IM) vitamin B12 (3 doses on alternate days for those aged <10 year, five doses for age >10 year), followed by monthly 1000 µg IM for the subsequent two doses. Group B was given daily oral vitamin B12 1500 µg (500 µg in <2 years age) for three months. Folic acid and iron supple-mentation, and relevant dietary advice were given to both groups in a similar fashion. Improvement in serum vitamin B12 levels and total hemoglobin was compared three months post-treatment. The median(IQR) increase in serum vitamin B12 level was significantly higher in group A [600 (389,775) vs 399 (313, 606) pg/mL; P= 0.016]. The median (IQR) rise of hemoglobin was also more in group A [2.7 (0.4,4.6) vs 0.5 (-0.1,1.2) g/dL; P=0.001]. Increase in serum vitamin B12 levels and hemoglobin was better in children with nutritional macrocytic anemia receiving parenteral as compared to oral vitamin B12.

Effectiveness of Multimodal Ayurvedic Treatment in Vataja Pandu w.s.r Nutritional Deficiency Anemia - A Case Report

Panduroga is a condition where in Pitta Pradhana Tridoshas affect the Dhathus causing deterioration of Varna and Bala, leading to Twak Vaivarnyatha or Pandutha. In present day medical science, symptoms of Pandu are alike to that of anaemia. Anemia is a condition presenting with a depletion of hemoglobin concentration below normal values, or Hematocrit or Red blood cells in the blood. On an average, about 30% or nearly one third of world’s population is claimed to be affected by anemia because of numerous causes. In India prevalence is extremely high compared to world prevalence, close to 51%. Nutritional macrocytic anemia (NMA) in prevailing population and in pregnancy, commonly seen in India, most likely represents combined deficiency of iron, folic acid and vitamin B12. A 45 years old female presented with complaints of Panduta (Pallor of skin), Daurbalya (weakness), Aruchi (loss of appetite), Padashopha (pedal oedema), Pindikodweshtana (leg cramps), Shrama Shwasa (exertional dyspnoea) and Hriddrava (palpitation) with haemoglobin concentration 3.7gm% visited OPD of SJIIM, GAMC, Bengaluru. Initially she was started with oral medications followed by admission to in-patient ward on the succeeding visit. The present case study is intended to understand the accuracy of multimodal Ayurvedic approach consisting of oral medications and Matra Basti with Dadimadya Ghrita, in the management of Panduroga and is found to be effective in overcoming Vataja Pandu

Nutritional Macrocytic Anemia of Infancy and Childhood

Nutritional Macrocytic Anemia of Infancy and Childhood

Vitamin E-Responsive Macrocytic Anemia in Protein-Calorie Malnutrition: Measurements of Vitamin E, Folic Acid, Vitamin C, Vitamin B12and Iron

Six children with nutritional macrocytic anemia, all of whom had a megaloblastic bone marrow of varying degree, were treated with vitamin E. Reticulocyte response occurred in all patients, to a variable degree, but some megaloblastosis persisted which involved red cell and/or white cell precursors. Serum folate and vitamin C levels increased after vitamin E therapy. The effect on serum vitamin B12was uncertain. Serum iron levels fell in three patients and remained the same in two patients.

Severe Nutritional Macrocytic Anemia in Emotionally Disturbed Patients

Severe Nutritional Macrocytic Anemia in Emotionally Disturbed Patients

Rise of serum folic acid-levels after injection of vitamin B12 in nutritional macrocytic anaemia.

ALTHOUGH certain similarities between folic acid and vitamin B12 as agents involved in haemopoiesis, nucleic acid synthesis and single-carbon transfers are well known, there is very little information on the manner in which these two chemically dissimilar vitamins affect each other. We wish to make a preliminary report of observations which show that the administration of vitamin B12 causes a rise in the serum folic acid - level in patients with nutritional macrocytic anaemia.

Metabolic Interrelations between Gastric Intrinsic Hematopoietic Factor and Vitamin B12: II. Further Assays of Vitamin B12 in Blood and Urine of Patients with Pernicious Anemia and Following Total Gastrectomy by Means of Escherichia coli mutant and Euglena gracilis Technics

Abstract The concentration of vitamin B12 in blood serum and its excretion in the urine were assayed by the E. coli mutant technic in two patients after total gastrectomy and by use of the more sensitive Euglena gracilis method in four cases of pernicious anemia in relapse and 1 case of well controlled nutritional macrocytic anemia. Following parenteral administration of 100 µg. vitamin B12 intramuscularly to two patients with total gastrectomy, much higher blood levels were observed within the first few hours than those reported by others under similar circumstances in normals. Following oral administration of vitamin B12 together with a potent intrinsic factor concentrate from hog stomach, a rise in blood levels of vitamin B12 was observed in patients with pernicious anemia. The normal serum levels of vitamin B12 could not be maintained, however, for the entire duration of the oral treatment, in spite of the apparent hematologic and clinical remission. The urinary output of vitamin B12 was in all instances less than 0.5 per cent of the total dose of vitamin B12 ingested during the experimental period, in spite of an optimal or suboptimal hematopoietic response obtained. A similar situation existed in patients with total gastrectomy, as well as in the patient with controlled macrocytic nutritional anemia, when vitamin B12 was ingested alone or with intrinsic factor concentrate. The intensity of the obtained hematopoietic response in patients with pernicious anemia indicates the absorption of much larger amounts of vitamin B12 from the intestine than is indicated by the total urinary output of vitamin B12; therefore the anchorage and retention of a large part of vitamin B12 in the storage depots of the body after its absorption from the intestine must occur. A sharp increase in the urinary output of vitamin B12 was observed during or immediately following the hematopoietic response in all patients with pernicious anemia treated orally with vitamin B12 and intrinsic factor concentrate, i.e., coincident with or immediately following the reticulocyte peak in blood. Similar observation was reported by the authors in the previous series of investigations. Of many possible interpretations of this finding, the most plausible appears to be the metabolic release of free vitamin B12 from its complex binding in the body during hyperactivity of the hematopoietic organs and its escape through the kidneys.

Vitamin B12 in nutritional macrocytic anaemia.

Vitamin B12 in nutritional macrocytic anaemia.

Vitamin B12 in megaloblastic anemia of pregnancy and tropical nutritional macrocytic anemia: Chaudhuri, S.: Brit. M. J.2: 825, 1951

Vitamin B12 in megaloblastic anemia of pregnancy and tropical nutritional macrocytic anemia: Chaudhuri, S.: Brit. M. J.2: 825, 1951

Experimental Production of Nutritional Macrocytic Anemia in Swine: V. Hematologic Manifestations of a Combined Deficiency of Vitamin B12 and Pteroylglutamic Acid

Abstract A total of 20 swine were fed a diet adequate in all known respects except that soybean protein was substituted for casein, succinylsulfathiazole and a folic acid antagonist were added, and vitamin B12 and pteroylglutamic acid were withheld from the vitamin supplement. The animals developed macrocytic anemia, leukopenia and neutropenia, accompanied by erythroid hyperplasia of the bone marrow. Tue erythroblasts consisted mainly of immature macronormoblasts but a few atypical megaloblasts were also observed. The anemia responded rapidly and completely to the administration of both vitamin B12 and pteroylglutamic acid. The administration of pteroylglutamic acid alone resulted in an immediate return of the blood and bone marrow to within normal limits but after several months there was a partial hematologic relapse in spite of continued therapy with this vitamin. The administration of vitamin B12 alone resulted in only partial remission of the anemia and the bone marrow remained macronormoblastic although the megaloblasts tended to disappear. Growth of the animals was stimulated by the administration of either vitamin but the administration of both vitamins simultanseously resulted in the greatest rate of growth. No manifestations of neurologic disturbances or of inscreased pigment excretion were observed in the deficient swine.

The Effects of Combined Folic Acid and Liver Extract Therapy

Abstract 1. Folic acid, when administered alone, did not prevent the development or progression of subacute combined degeneration in 12 of 22 patients receiving this agent for from twelve to twenty-five months. 2. One patient with total gastrectomy and a macrocytic anemia developed subacute combined degeneration after five months of folic acid therapy. 3. Neurologic disease did not develop in 6 pernicious anemia patients treated with folic acid and liver extract for three and one-half to thirty-nine months. 4. In 10 pernicious anemia patients with good nutrition, neurologic relapses did not progress when liver extract or vitamin B12 therapy was instituted, even though folic acid therapy was continued. In 2 patients with abnormal nutrition and complicating organic abnormalities, nervous system disease progressed after institution of liver extract therapy. 5. Our observations are best explained by the theory that the hematologic and neurologic manifestations of pernicious anemia and other macrocytic anemias associated with gastro-intestinal tract pathology and inadequate nutrition are due to a deficiency of more than one substance. The administration of folic acid may improve the hematologic status but induce a deficiency of another substance or substances, e.g., vitamin B12, which are essential for the maintenance of a normal blood picture and the integrity of the central nervous system. This deficiency will eventually result in the development of a suboptimal blood picture or subacute combined degeneration of the spinal cord, or both. 6. The hematologic status of patients with pernicious anemia is not maintained in a more satisfactory state by supplementation of liver extract or vitamin B12 therapy with folic acid. 7. Folic acid therapy did not produce neurologic disease in patients with iron deficiency anemia who had free gastric hydrochloric acid in their gastric secretions and presumably sufficient intrinsic factor. It did not influence response to ferrous sulfate therapy. 8. Patients with sprue, nutritional macrocytic anemia and other macrocytic anemias associated with gastro-intestinal tract pathology who are treated with folic acid should also be given supplemental liver extract or vitamin B12 to insure against the development of nervous system disease.

Vitamin B12 in megaloblastic anaemia of pregnancy and tropical nutritional macrocytic anaemia.

Vitamin B12 in megaloblastic anaemia of pregnancy and tropical nutritional macrocytic anaemia.

Pernicious Anemia in Asiatic Indians

Abstract Three cases of pernicious anemia in Asiatic Indians are reported. The prevailing idea regarding the low incidence of pernicious anemia in Indians is corroborated. The pathogenesis of pernicious anemia and nutritional macrocytic anemia is discussed briefly.

Therapeutic effect of aureomycin in pernicious anemia

ConclusionsFour patients with Addisonian pernicious anemia in relapse and one patient with nutritional macrocytic anemia were treated with aureomycin given orally, with definite although submaximal hematological improvement. A fifth patient with Addisonian pernicious anemia was treated with aureomycin given intravenously with no response.We are indebted to Mrs. Helen Jakubowski for performing the blood examinations.

Vitamin B12: A Nutritional Factor for Man and Beast

One hundred years ago Thomas Addison (1) recognized as a clinical entity the disease known as pernicious anemia. The anemia is characterized by insidious onset, by the presence of abnormally large red blood cells, a deficiency of gastric secretion, and certain gastrointestinal and neurologic disturbances. The designation, pernicious , which implies a fatal outcome, has become inadequate since the advent of liver therapy. It was in 1926 that Minot and Murphy (2) made the important observation that the feeding of whole liver to patients with pernicious anemia results in a relatively rapid remission of most symptoms, only those due to irreversible pathologic changes occurring before liver therapy being refractory to such treatment. Experimental evidence for the value of liver had been demonstrated the year before by Whipple (3) in dogs with hemorrhagic anemia. Although pernicious anemia had been considered by most clinicians as being due to a toxic or infectious agent, it now appeared that a deficiency of a nutritional factor was the cause of the disease. Subsequent studies by Castle and associates (4) clarified somewhat the rel-ationship of food to pernicious anemia. Castle postulated that certain fods, such as eggs or lean beef, contained an factor which when acted upon by the factor, secreted by the normal stomach, yielded the erythrocyte maturation factor or anti-pernicious anemia factor, which was then stored in * Presented before Joint Session of the Science Teaching Societies, American Association for the Advancement of Science, December 28, 1949, New York City. the liver. The basic defect in a patient with pernicious anemia is an inability to produce intrinsic factor in the stomach. If gastric juice from a normal person (containing intrinsic factor) is incubated with beef muscle or another source of extrinsic factor and then administered to a pernicious anemia patient a satisfactory clinical response is obtained just as when liver itself is given. With the knowledge that liver is effective in the treatment of pernicious anemia, investigators from all over the world set out to isolate and identify the active principle therein. Concentrates were made which reduced considerably the size of the dose needed. Some patients, however, objected to the unpalatability of the concentrates as much as they had to the large amounts of whole liver which had to be taken by mouth. Finally it was posible to prepare highly refined liver extracts which were much less expensive than liver itself and which could be given by injection. A more accurate dose could be given by injection and the response by this route of administration was found to be more rapid than when liver or liver preparations were given orally. Furthermore treatment could be given at intervals of two or more weeks instead of daily. In recent years a crystalline vitamin of the B-complex, called pteroylglutamic or folic acid was isolated and then synthesized. This was found to be effective in the treatment of the anemia of pernicious anemia, sprue and nutritional macrocytic anemia. Used in milligram doses it brought about a rise in the

Therapeutic effect of aureomycin in pernicious anemia.

ConclusionsFour patients with Addisonian pernicious anemia in relapse and one patient with nutritional macrocytic anemia were treated with aureomycin given orally, with definite although submaximal hematological improvement. A fifth patient with Addisonian pernicious anemia was treated with aureomycin given intravenously with no response.We are indebted to Mrs. Helen Jakubowski for performing the blood examinations.

Vitamin B12 in macrocytic anaemia of pregnancy and the puerperium.

It has been conclusively proved that vitamin B 12 is haemopoietically effective in Addisonian pernicious anaemia and subacute combined degeneration (West, 1948; Berk et al., 1948; Ungley, 1948a; Spies et al., 1949; Hall and Campbell, 1948a, 1948b), in nutritional macrocytic anaemia and sprue (Spies et al., 1948a, 1948b, 1949), and in tropical macrocytic anaemia (Patel, 1948). But the reported results of treatment of macrocytic anaemia of pregnancy with vitamin B 12 have not been encouraging. Ungley (1948b) was unsuccessful with 65 μg. of vitamin B 12 in a case of megaloblastic anaemia of pregnancy which responded afterwards to 2.5 mg. of folic acid (pteroylglutamic acid) given daily. Bethell et al. (1948) treated one case of puerperal macrocytic anaemia with 1/g. of vitamin B 12 for 10 days without any response, though it subsequently responded to 10 mg. of folic acid administered daily. Day et al. (1949) treated a case of macrocytic anaemia of pregnancy with a total of 27.5μg. of vitamin B 12 without any response, though there was subsequent response to folic acid. We here present the results of the treatment of five cases of macrocytic anaemia of pregnancy and the puerperium with vitamin B 12 .

Experimental production of a nutritional macrocytic anemia in swine

Experimental production of a nutritional macrocytic anemia in swine

VITAMIN B 12 BY MOUTH IN PERNICIOUS AND NUTRITIONAL MACROCYTIC ANÆMIA AND SPRUE

VITAMIN B 12 BY MOUTH IN PERNICIOUS AND NUTRITIONAL MACROCYTIC ANÆMIA AND SPRUE

Nutritional Macrocytic Anaemia

Nutritional Macrocytic Anaemia