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Copyright ©2009 The WJG Press and Baishideng.
World J Gastroenterol. Oct 7, 2009; 15(37): 4627-4637
Published online Oct 7, 2009. doi: 10.3748/wjg.15.4627
Table 5 Causes of megaloblastic anemia
Cobalamin deficiency
Poor diet
Deficiency of intrinsic factor
Pernicious anemia
Total or partial Gastrectomy
Ingestion of caustic (lye)
Functional defect of intrinsic factor
Alteration of ileal (microenvironment)
Insufficient pancreatic protease activity
Inactivation enzyme (Sd. Zollinger-Ellison)
Competition for cobalamin
Alteration of ileal mucosa
Acquired
Surgical resection or by-pass
Regional enteritis (Crohn’s disease)
Tropical esprue
Celiac disease, Tuberculosis
Lymphomatous infiltration
Induced by drugs
Congenital
Sd Immerslund-Gräsbeck
Congenital transcobalamin II deficiency or abnormality
Congenital methylmalonic acidemia and aciduria
Hemodialysis
Urinary losses (congestive heart failure)
Folate deficiency
Dietary
Old age, infancy, poverty, alcoholism, chronic invalids, psychiatrically disturbed, scurvy and kwashiorkor
Excess utilization or loss
Physiologic: pregnancy and lactation, prematurity
Pathologic: Hematologic diseases
Malignant diseases
Inflammatory disease
Metabolic disease
Excess urinary loss, congestive heart failure, active liver disease
Hemodialysis, peritoneal dialysis
Malabsorption
Congenital
Anti-folate drugs
Alcoholism
Tropical sprue, gluten-induced enteropathy
Extensive jejune resection, Crohn’s disease, partial gastrectomy, systemic bacterial infection, Whipple’s disease
Congenital abnormalities of folate metabolism
Cyclohydrolase, methionine synthetase
Combined deficit of folate and cobalamin
Celiac disease
Regional enteritis (Crohn’s disease)
Congenital disorder of DNA synthesis
Disorders of DNA synthesis induced by drugs
Anti-folate
Purine antagonists
Pyrimidine antagonists
Alkylating
Eritroleucemia