Megaloblastic Anemia: Diagnosis and Treatment

Diagnosis

• A medical history and physical examination are the first steps.
  
• Blood testing diagnoses these disorders and distinguishes between the two.
  
  Note that the tests for vitamin B₁₂ and folic acid levels may be rendered unreliable by pregnancy, alcohol intake, recent nutritional changes, or certain medications.
  
• Bone marrow biopsy is usually not necessary for diagnosis, but may be recommended in some cases.
  

Treatment

• The underlying cause of vitamin B₁₂ or folate deficiency must be identified to ensure adequate long–term treatment.
  
• Vitamin B₁₂ injections are usually given daily for one week, then weekly for four weeks, and then monthly until vitamin levels have stabilized. Patients with continued risk of deficiency should remain on monthly injections. Oral vitamin B₁₂ pills may be used in some patients.
  
• Oral folic acid pills taken daily for several months usually correct the deficiency.
  
• Alcohol use should be restricted. In individuals with alcoholic tendencies, psychiatric treatment along with substance abuse counseling and Alcoholics Anonymous meetings or other community support may be necessary.