Department of Pathology and Laboratory Medicine, UC Davis Medical Center, University of California Davis Health System, 4400 V. Street, Sacramento, CA 95817, USA.
Department of Pathology and Laboratory Medicine, UC Davis Medical Center, University of California Davis Health System, 4400 V. Street, Sacramento, CA 95817, USA.
Med Clin North Am. 2017 Mar;101(2):297-317. doi: 10.1016/j.mcna.2016.09.013. Epub 2016 Dec 14.
Vitamin B and folate deficiencies are major causes of megaloblastic anemia. Causes of B deficiency include pernicious anemia, gastric surgery, intestinal disorders, dietary deficiency, and inherited disorders of B transport or absorption. The prevalence of folate deficiency has decreased because of folate fortification, but deficiency still occurs from malabsorption and increased demand. Other causes include drugs and inborn metabolic errors. Clinical features of megaloblastic anemia include anemia, cytopenias, jaundice, and megaloblastic marrow morphology. Neurologic symptoms occur in B deficiency, but not in folate deficiency. Management includes identifying any deficiency, establishing its cause, and replenishing B or folate parenterally or orally.
维生素 B 和叶酸缺乏是巨幼细胞性贫血的主要原因。B 族维生素缺乏的原因包括恶性贫血、胃切除术、肠道疾病、饮食缺乏以及 B 族维生素转运或吸收的遗传性疾病。由于叶酸强化，叶酸缺乏的患病率有所下降，但由于吸收不良和需求增加，仍会发生叶酸缺乏。其他原因包括药物和先天性代谢错误。巨幼细胞性贫血的临床特征包括贫血、血细胞减少、黄疸和巨幼细胞骨髓形态。神经症状发生在 B 族维生素缺乏，但不在叶酸缺乏。治疗包括确定任何缺乏，确定其原因，并通过肠外或口服补充 B 族维生素或叶酸。
