Page 79 - Essential Haematology

Chapter 5 Macrocytic anaemias / 65

Table 5.5 Causes of folate defi ciency.

Nutritional
Especially old age, institutions, poverty, famine,
special diets, goat ’ s milk anaemia, etc.
Malabsorption
Tropical sprue, gluten - induced enteropathy
(adult or child). Possible contributory factor to
folate defi ciency in some patients with partial
gastrectomy, extensive jejunal resection or
Crohn ’ s disease
Excess utilization
Physiological
Pregnancy and lactation, prematurity
Pathological
Haematological diseases: haemolytic anaemias,
myelofi brosis
Malignant disease: carcinoma, lymphoma,
myeloma
Infl ammatory diseases: Crohn ’ s disease,
tuberculosis, rheumatoid arthritis, psoriasis,
exfoliative dermatitis, malaria

Excess urinary folate loss Figure 5.6 Megaloblastic anaemia: pallor and mild
Active liver disease, congestive heart failure icterus in a patient with a haemoglobin count of
7.0 g/dL and a mean corpuscular volume of 132 fL.
Drugs
Anticonvulsants, sulfasalazine
Mixed
Liver disease, alcoholism, intensive care

Alcohol, sulfasalazine and other drugs may have
multiple effects on folate metabolism.

Clinical f eatures of m egaloblastic
a naemia

The onset is usually insidious with gradually pro-
gressive symptoms and signs of anaemia (see

Chapter 2 ). The patient may be mildly jaundiced
(lemon yellow tint) (Fig. 5.6 ) because of the excess
breakdown of haemoglobin resulting from increased
ineffective erythropoiesis in the bone marrow.

Glossitis (a beefy - red sore tongue) (Fig. 5.7 ), angular Figure 5.7 Megaloblastic anaemia: glossitis – the

stomatitis (Fig. 5.8 ) and mild symptoms of malab- tongue is beefy - red and painful.