{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:15:48Z","timestamp":1790705748998,"version":"4.1.0"},"reference-count":56,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T00:00:00Z","timestamp":1641168000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In this review of megaloblastic anemia (MA), an overview of vitamin B<jats:sub>12<\/jats:sub> and folate body requirements, biochemical pathways, and laboratory testing strategies will be provided. However, the focus of this review is the classic and unique features of MA in blood and bone marrow. Acquired MA is a benign disorder for many, but can be detrimental for some. The clinical presentation can vary considerably, and the spectrum of symptoms and signs is diverse and quite broad. Prompt recognition and therapy are critical to prevent potential irreversible damage and clinical sequelae, especially in patients with vitamin B<jats:sub>12<\/jats:sub> deficiency. A delay in diagnosis of vitamin B<jats:sub>12<\/jats:sub> deficiency can result in significant neurologic sequelae that may not fully resolve with treatment, including in neonates and young infants. The blood and bone marrow features in MA can closely mimic thrombocytopenic purpura, myelodysplasia, and other myeloid neoplasms. Both pancytopenia and normal MCV at presentation are common in MA and raise unique challenges for the diagnostician. Partially treated MA is also a significant diagnostic \u201ctrap\u201d. MA is highly responsive to treatment, and patients tend to improve rapidly upon treatment initiation. However, the broad range of clinical and hematologic features makes the rapid, successful diagnosis of MA a unique challenge for the hematopathologist. Even in the era of state\u2010of\u2010the\u2010art laboratory testing, a high suspicion is required.<\/jats:p>","DOI":"10.1111\/ijlh.13789","type":"journal-article","created":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T05:35:29Z","timestamp":1641274529000},"page":"236-247","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["How I investigate acquired megaloblastic anemia"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1792-5160","authenticated-orcid":false,"given":"Mary","family":"Torrez","sequence":"first","affiliation":[{"name":"Department of Pathology University of New Mexico Health Sciences Center Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6437-8438","authenticated-orcid":false,"given":"Devon","family":"Chabot\u2010Richards","sequence":"additional","affiliation":[{"name":"Department of Pathology University of New Mexico Health Sciences Center Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1968-0061","authenticated-orcid":false,"given":"Daniel","family":"Babu","sequence":"additional","affiliation":[{"name":"Department of Pathology University of New Mexico Health Sciences Center Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Lockhart","sequence":"additional","affiliation":[{"name":"Department of Pathology University of New Mexico Health Sciences Center Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5143-4835","authenticated-orcid":false,"given":"Kathryn","family":"Foucar","sequence":"additional","affiliation":[{"name":"Department of Pathology University of New Mexico Health Sciences Center Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,3]]},"reference":[{"issue":"2","key":"e_1_2_11_2_1","first-page":"407","article-title":"Historical review: a history of pernicious anaemia","volume":"111","author":"Chanarin I","year":"2000","journal-title":"Br J Haematol"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-10-569186"},{"key":"e_1_2_11_4_1","article-title":"Vitamin B\u201012 deficiency: the serious health problem that's easy to miss; one woman's health saga sheds light on a condition that is all too common and often goes undiagnosed by doctors","author":"Hawkins\u2010Simons D","year":"2019","journal-title":"Wall Street J"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23421"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1113996"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3121\/cmr.4.3.236"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2016.09.013"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1508861"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-7125(16)30341-8"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-553X.2007.00911.x"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijlh.13205"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g5226"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijlh.12833"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hct142"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.17099"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijlh.12933"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12959"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1204070"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.30.12.1686"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.314.7078.430"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2018-205048"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.87a.19072"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2014.01.042"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.1992.tb06880.x"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.advms.2015.12.004"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198806303182604"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.49.10.1203"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-03-040253"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1988.00380080016007"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2018.03.001"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCP50AEEYGREWUZ"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPRKYAT6EZQHC7"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1080\/08998280.2019.1641045"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-012-1488-0"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23987"},{"key":"e_1_2_11_37_1","article-title":"Reversal of isolated 20q deletion with vitamin B12 replacement in a patient with pernicious anaemia","volume":"2017","author":"Cingam SR","year":"2017","journal-title":"BMJ Case Rep"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.2012.04259.x"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2016.08.005"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12878-015-0036-2"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijlh.12856"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2018.01.003"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-4887.2008.00031.x"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2009.12.003"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.braindev.2014.05.006"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-020-0804-x"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-200404000-00013"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mph.0000212958.89091.c0"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1975.tb00834.x"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-90-5-757"},{"key":"e_1_2_11_51_1","first-page":"159","article-title":"The sternal marrow in pernicious anemia. Correlation of the observations at biopsy with the blood picture and the effects of specific treatment in megaloblastic (\"liver deficient \") hyperplasia","volume":"23","author":"Dameshek W","year":"1937","journal-title":"Arch Pathol"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.111.013441"},{"key":"e_1_2_11_53_1","article-title":"Ethnicity influences total serum vitamin B12 concentration: a study of Black, Asian and White patients in a primary care setting [published online ahead of print, 2021 May 5]","author":"O'Logbon J","year":"2021","journal-title":"J Clin Pathol"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnutbio.2019.04.008"},{"issue":"2","key":"e_1_2_11_55_1","first-page":"155","article-title":"Vitamin B12 deficiency in the elderly: is it worth screening?","volume":"21","author":"Wong CW","year":"2015","journal-title":"Hong Kong Med J"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2005.061382"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1258\/acb.2011.011039"}],"container-title":["International Journal of Laboratory Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijlh.13789","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ijlh.13789","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijlh.13789","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T22:53:51Z","timestamp":1693004031000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijlh.13789"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,3]]},"references-count":56,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1111\/ijlh.13789"],"URL":"https:\/\/doi.org\/10.1111\/ijlh.13789","archive":["Portico"],"relation":{},"ISSN":["1751-5521","1751-553X"],"issn-type":[{"value":"1751-5521","type":"print"},{"value":"1751-553X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,3]]},"assertion":[{"value":"2021-03-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}