Pediatric Megaloblastic Anemia Differential Diagnoses

Updated: Dec 16, 2021
  • Author: James L Harper, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Diagnostic Considerations

In a patient with combined folate and vitamin B-12 deficiency, if only the folate deficiency is recognized, folic acid supplementation may be sufficient to drive the production of active 5 methyl tetrahydrofolate (THF) in the absence of vitamin B-12. This results in improvement of the anemia but does not result in improvement of the function of other pathways dependent on B-12.

Clinically, this is apparent as a resolution of megaloblastic anemia, but with progressive dementia and long-tract neurologic deficits. This situation can be avoided by measuring levels of both vitamins, then evaluating and treating both deficiencies, if found.

Other conditions to consider include the following:

  • Aplastic anemia

  • Celiac disease

  • Ecchymoses

  • Granulocytopenia

  • Hyposplenism

  • Myeloproliferative disorders

  • Neutropenia

  • Pancytopenia

  • Tapeworm infection (cestodiasis)

  • Imerslund-Grasbeck disease

  • Thiamine-responsive megaloblastic anemia [2, 3]

Go to Pediatric Chronic Anemia, Anemia of Prematurity, Donath-Landsteiner Hemolytic Anemia, Pediatric Acute Anemia, and Fanconi Anemia for complete information on these topics.

Differential Diagnoses