Megaloblastic Anemia of Pregnancy: Characteristics of Pure Megaloblastic Anemia and Megaloblastic Anemia Associated with Iron Deficiency

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Abstract
Morphology of the peripheral blood and bone marrow, iron, folic acid and vitamin B12 metabolism and estimation of erythrokinetics have been made in 17 patients with megaloblastic anemia of pregnancy. The peripheral blood showed the classic picture of megaloblastic anemia of pregnancy previously reported. Nine cases exhibited megaloblastic series in the marrow and 8 cases intermediate megaloblastic series. Folic acid malabsorption was observed in 12 cases. The malabsorption was still present after remission in 6 of 7 cases studied. Folic acid induced complete or partial remission in all the cases but one. In cases with partial remission iron deficiency anemia developed and responded adequately to iron therapy. The average of the serum level of vitamin B12 showed a diminution of approximately 39 per cent below normal level. Normal pregnant women belonging to the same social condition of the patients and well-to-do pregnant women showed the same reduction. The erythrokinetics demonstrated that megaloblastic hyperplasia and iron turnover values do not correlate with the reticulocyte count. This indicates that the marrow activity was ineffective in terms of red cell production. This marrow dysfunction was associated with an increased rate of red cell destruction: approximately 4 times normal. The clinical and laboratory data collected suggest the division of megaloblastic anemia cf pregnancy into two types: pure megaloblastic anemia of pregancy, and megaloblastic anemia associated with iron deficiency. The morphologic characteristics, the amount of hemosiderin contained in the bone marrow, the reticulocyte count, plasma iron, T ½ plasma iron clearance, plasma iron turnover, and response to treatment may permit one to separate one type from another.