A patient with megaloblastic anemia may fail to respond to vitamin replacement therapy. This can often be traced to the presence of one or more factors.
Reasons for megaloblastic anemia not responding to vitamin therapy:
(1) noncompliance
(2) malabsorption of orally administered drug
(3) incorrect diagnosis (not vitamin B12 or folate deficiency)
(4) combined vitamin B12 and folate deficiency treated with only 1 vitamin
(5) vitamin dose insufficient to meet demands
(6) alcohol abuse
(7) presence of iron deficiency
(8) presence of hemoglobinopathy
(9) presence of anemia of chronic disease
(10) presence of hypothyroidism
(11) presence of myelodysplasia
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