Megaloblastic Anemia of Infancy
This disease is caused by a deficient intake or absorption of folic acid.
Folates are abundant in many foods that include:
– green vegetables
– fruits and
– animal organs like liver and kidney.
– human and cow’s milk
The normal adult daily requirement is about 100 ug/ 24 hour which rises to 350 ug/ 24 in pregnancy.
The pediatric age range has higher needs due to increased demands of growth.
The needs also increased with accelerated tissue turnover as in hemolytic anemia.
Clinically, megaloblastic anemia will present with very low birthweight, irritability, failure to gain weight adequately, and chronic diarrhea.
Hemorrhages can be seen in advanced cases. There could also be kwashiorkor and marasmus.
Folate requirements increase markedly in pregnancy to also meet fetal needs.
It is recommended that folate supplementation at 1 mg/ 24 hr is given during the last trimester of pregnancy.
There is an autosomal recessive defect called Congenital Folate Malabsorption and what happened here is that there is a defect in intestinal absorption of folic acid with inability to transfer folate from the plasma to the central Nervous system.
This could present as megaloblastic anemia, convulsions, mental retardation and cerebral calcifications. Infants should be treated and manage well to correct the hematologic defect and to prevent neurologic deterioration.