Page 84 - Essential Haematology

70 / Chapter 5 Macrocytic anaemias

mins after blood has been taken for B 12 and folate although giant metamyelocytes persist for up to
estimation and a bone marrow test has been per- 12 days.

formed. In the elderly, the presence of heart failure The peripheral neuropathy may partly improve
should be corrected with diuretics. Blood transfu- but spinal cord damage is irreversible. Th e shorter
sion should be avoided if possible as it may cause the history of neurological symptoms, the greater
circulatory overload. the chance of recovery.

Response to t herapy Prophylactic t herapy

The patient feels better after 24 – 48 hours of correct Vitamin B 12 is given for life to patients who have
vitamin therapy with increased appetite and well - total gastrectomy or ileal resection. Folic acid is

being. The haemoglobin should rise by 2 – 3 g/dL given in pregnancy at a recommended dosage of

each fortnight. The white cell and platelet counts 400 μ g/day and all women of child - bearing age
become normal in 7 – 10 days (Fig. 5.13 ) and are recommended to have an intake of at least
the marrow is normoblastic in about 48 hours, 400 μ g/day (by increased intake of folate - rich or

Hydroxocobalamin 1 mg i.m.

15 30

Reticulocytes 20
Haemoglobin (g/dL) 5 Haemoglobin 10 Reticulocytes (%)
10

0 0
400

300 Platelets 15
Platelets (x 10 9 /L) 200 10 White blood cells (x 10 9 /L)

100 5
White blood cells

0 0
0 2 4 6 8 10 12 14 60
Day

Figure 5.13 Typical haematological response to vitamin B 12 (hydroxocobalamin) therapy in pernicious anaemia.