This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the differential diagnosis for macrocytic anemia
2. Describe the treatment for Vitamin B12 and Folate Deficiency
Estimated time to complete activity: 0.5 hours
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 7/9/2021 through 7/9/2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.5 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.Read Disclaimer & Fine Print
Macrocytic anemia is defined by a mean corpuscular volume (MCV) >100 fL. In simple terms, this means the red blood cells are larger than normal. The most common causes of macrocytic anemia are alcoholism, vitamin B12 and folate deficiencies, and medications. Vitamin B12 (cobalamin) is a water-soluble vitamin commonly found in fish, meat, and dairy products. It is involved in neurologic function, red blood cell production, and as a cofactor for enzymes involved in DNA synthesis and metabolic function. Folate (Vitamin B9) is involved as a cofactor for many enzymes involved in DNA synthesis and metabolic function, similar to vitamin B12
Lack or Impairment of Absorption
Normal physiology: Vitamin B12 is dissociated from food proteins by gastric acid and is then absorbed in the small intestine by binding with intrinsic factor which is secreted by parietal cells in the stomach
Folate Deficiency (Vitamin B9)
Peripheral Blood Smear
Additional Testing for Megaloblastic Anemia with High Suspicion for Vitamin B12/Folate Deficiency
Note: Serum folate level fluctuates rapidly with dietary intake and are thus not useful in determining folate stores and folate deficiency
Non-Megaloblastic Process or Negative B12/Folate Deficiency
Note: Guidelines recommend 1mg of oral vitamin B12 daily in gastric surgery patients due to the high risk and prevalence of vitamin B12 deficiency in this population
Vitamin B12 Deficiency: Recognition and Management
ACOG Practice Bulletin 187: Neural Tube Defects
American Society for Clinical Pathology – Blood folate levels: Choosing Wisely
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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