The Value of Duodenal Biopsies in the Evaluation of Megaloblastic Anemia (original) (raw)
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Journal of College of Medical Sciences-Nepal, 2012
Megaloblastic anemia is not uncommon, however varied of presentation makes difficult to come to conclusion. It’s more difficult when resources are limited. In this back ground clinical features of megaloblastic anemia are very important for diagnosis and treatment. It is a retrospective analysis of data from December 2003 to September 2009. During the period, bone marrow aspiration was done for analysis of cause and type of anemia.A total of 14 cases bone marrow findings was consistent with megaloblastic anemia. These reports were taken into consideration after pathologist impression. Serum Vitamin B12 and RBC folate were not done in view of limited resources and financial constrain. In the analysis 14 (11.96%) bone marrow findings were consistent with megaloblastic anemia. Regarding clinical presentation; pallor was 13 (92.85%) followed by glossitis 5 (35.71%) and Jaundice 5 (35.71%), paresthesia 3 (21.42%), and pigmentation, ataxia, confusion each case (7.14 %). Mostly the patient...
Evaluation of Clinical Profile and Hematological Parameters of Cases of Megaloblastic Anemia
National Journal of Community Medicine, 2017
Background: Megaloblastic anemia is not uncommon in India. In India, the most common cause of megaloblastic anemia is nutritional where as it is the pernicious anemia in Northern Europe. Aims and objectives: To study age and gender-wise distribution, diet patterns, clinical features and hematological parameters in patients with megaloblastic anemia. Material and methods: This was an observational cross-sectional study of the hundred patients of megaloblastic anemia. We included patients having anemia with MCV>100 fL, serum vitamin B12 level <250 pg/ml and/ or serum folic acid level<3 ng/ml with normal serum ferritin level were included. Detailed history, physical examination, laboratory parameters and radiological investigation were done. Results: Megaloblastic anemia is most common in age between 20-40 years of age. Male subjects were commonly affected. Most of the patients (69%) belong to lower socio-economic class. 50% patients had severe anemia (Hb<7 gm %). Cobalamin deficiency was responsible for megaloblastic anemia in the majority of patients. Conclusion: Megaloblastic anemia has wide clinical & hematological spectrum. The most common symptoms observed were a generalized weakness (98%), easy fatigability (96%), anorexia (64%) which is nonspecific, so high degree of suspicion is required to diagnose megaloblastic anemia.
A study on prevalence and causative factors of megaloblastic anaemia in Hadoti region
Annals of Applied Bio-Sciences, 2017
Background: Anaemia is the most common problems encountered by clinicians in Hadoti Region. The affected population includes male, female as well as children. Over the last two decades, it has been found that incidence of megaloblastic anaemia is increasing. Folic Acid and Vitamin B12 deficiency are the most common cause of megaloblastic anemia. Of these two micronutrients, Vitamin B12 deficiency is more common now, due to vegetarian life style of people. At present, Anemia control or prophylaxis program give only Iron and Folic acid. This study has been chosen to focus on this issue. The cases for increasing incidences of Folate / Vit. B12 deficiency needs to be elucidated. Objectives: To focus on the incidence of megaloblastic anaemia in Hadoti Region. & Probable Causative factors will be analysed Methods: All patients presenting to our hospital over a period of 2 months with a haemoglobin <10 g/dl and peripheral smear findings consistent with megaloblastic anaemia will be included in the study. Diet, drug intake, previous blood transfusion, presenting symptoms and other relevant history will be taken into consideration. Complete blood counts, peripheral film examination, reticulocyte count and cobalamin and folate assays will be recorded. Patients with chronic disease like renal disease, cancer, tuberculosis, liver disease etc will be excluded from the study. All data will be collected and evaluated statistically. Result: In the present study, total 500 patients who were admitted in medicine, paediatric and gynaecology ward were evaluated. All these patients met the inclusion criteria. Depending on the MCV value, serum assay and peripheral smear finding, they were categorised into 3 groups-Macrocytic, normocytic and microcytic anaemia. The normal MCV value but with megaloblastic blood film or low serum markers were considered into macrocytic anaemia. Total 100 patients were diagnosed as macrocytic anaemia. The sex distribution were-70(male), 30(female). Fifty five per cent of patients with cobalamin deficiency and 08% of patients with folate deficiency were found. All the patients were vegetarian and from middle class and low socio economic group. Conclusion: Cobalamin deficiency was responsible for megaloblastic anaemia in the majority of our patients. The supplementation program for Anemia control and prophylaxis should vary according to the regional requirements. Vitamin B12 should be included in the nutritional programme along with iron and folic acid. Awareness camp and Education program about megaloblastic anemia can be implemented for the prevention.
Clinico-Haematological and Biochemical Profile of Megaloblastic Anemia
Journal of Medical Science And clinical Research, 2018
Background: Megaloblastic anemia (MA) is a distinct type of anemia characterized by macrocytic RBCs and typical morphological changes in RBC precursors. The RBC precursors are larger than the cells of same stage and exhibit disparity in nuclear-cytoplasmic maturation. Basic underlying pathogenetic mechanism in MA is deficiency of folic acid (FA) and/or vitamin B12 at the cellular level with resultant impairment of DNA synthesis. In developing countries, most cases of MA result from nutritional deficiency of these micronutrients. Aims and Objectives 1. To correlate and compare the clinico-hematological and biochemical profile of megalo blastic anemia. 2 .To find out the clinical and haematological features of severe anemia. Materials and Methods: This descriptive study included 60 cases of megaloblastic anemia to evaluate Association of biochemical profile of megaloblastic anemia. Data collected from case files, patient history, clinical profile, Peripheral blood findings, haematological parameters and biochemical parameters. Results: In our study, megaloblastic anaemia was mostly found in <5 years of age. The male to female ratio was 1.7:1 in our study. The most common clinical presentation was pallor & generalised weakness (100 %) followed by easy fatigability (60 %), fever (28.3 %), altered behaviour (13.3%) and tingling (16.9%) are found. Bleeding (18.3%), itching and red spots (6.6%) are found in patients having thrombocytopenia. Megaloblastic anemiawas found mostly in vegetarians (71.6%). The mean haemoglobin was 7.3 gm/dl. Splenomegaly and hepatomegaly were present in 21.3 % and 26.6 % respectively. There was complete correlation between parameters in 27/60 (45 %) cases only. Conclusion: Inadequate dietary intake, overcooking of our food and poor absorption contributing high prevalence of megaloblastic anemia.
Journal of Ayub Medical College, Abbottabad : JAMC
Folate and vitamin B12 deficiencies have been known to cause megaloblastic anaemia. Since the deficiencies of these two vitamins are very common in Pakistani population, it would be imperative to investigate their role in causing megaloblastic anaemia. The objective of this study was to find out the contribution of folate and vitamin B12 deficiencies in causing megaloblastic anaemia in our patient population. In this retrospective cohort study, clinical records of 220 patients (101 females and 119 males with an age range of 1-80 years) who presented themselves with macrocytic anaemia at the Aga Khan University Hospital were collected. Data pertaining to complete blood count and serum levels of folate and vitamin B12 were analysed. The mean haemoglobin (Hb) level was 6.8 +/- 0.2 gm/dl. Sixty-nine percent of the patients had severe anaemia (Hb < 8 gm/dl). Mean +/- SEM values of haemoglobin, serum folate and serum B12 were not significantly different between males and females (Hb 6....
2018
Background: Vitamin B12 and folate deficiency is a well-known health problem worldwide. Deficiencies of folic acid and vitamin B12 are known to cause megaloblastic anaemia, which is characterised by presence of abnormally large erythrocyte precursor cells, megaloblasts, in the bone marrow and macrocytic red cells in the peripheral blood. These megaloblasts arise because of impaired deoxyribonucleic acid (DNA) synthesis followed by ineffective erythropoiesis. However, vitamin B12 or folate levels have not been described in Zambia, whether normal levels or in relation to anaemia. The study aimed to determine vitamin B12 and folate levels in megaloblastic anaemia, diagnosed morphologically, in patients at the University Teaching. Methods: This was a cross sectional study which was undertaken at the University Teaching Hospital (UTH) in Lusaka, Zambia. Full blood count (FBC), Peripheral smears and ELISA were assessed on blood samples received from megaloblastic anaemia and non-anaemic patients. Vitamin B12 and folate concentrations were compared between groups using t-test. Results: The age range was between 18-54 years (Mean age-31 years). Among the 40 megaloblastic patients, 35% (14/40) were male and 65% (26/40) were female with a male to female ratio of 1:1.9. Full blood count and peripheral smear findings revealed that bicytopenia was present in 22.5% (9/40) and pancytopenia in 72.5% (29/40) patients. Furthermore, the megaloblastic anaemia participants had statistically significant lower median vitamin B12 concentration 175(150-333) pg/ml than non-anaemic control participants 299.5 (238-571) pg/ml p=0.0001. Megaloblastic anaemia participants also had a statistically significant lower folate concentration (12.32± 2.28 ng/ml) than non-anaemic control participants (19.28 ± 2.84 ng/ml) p=0.029. Of the megaloblastic anaemia patients, vitamin B12 deficiency was in 60% (24/40), pure folate deficiency in 30% (12/40) and combined deficiency was observed in 15% (6/40) patients. Conclusion: This study shows that majority of patients with megaloblastic anaemia, diagnosed morphologically at the University Teaching Hospital have a deficiency of vitamin B12 deficiency which further implicates vitamin B12 and folate in the disease process of megaloblastic anaemia.
National Journal of Physiology, Pharmacy and Pharmacology, 2022
Background: Anemia can have severe implications on the health of children including motor development, behavioral and cognitive development. Furthermore, morbidity from infectious disease is higher in anemic children. Nutritional anemia is a major concern in rural India. Aim and Objective: We aimed to observe the percentage of megaloblastic anemia among the anemic children and their clinical and hematological parameters. Materials and Methods: After obtaining permission from the Institutional Ethics Committee, this cross-sectional study was conducted from September 2018 to August 2021. The setting was a tertiary care hospital in the eastern part of Odisha, India. Children of 1-14 years of age presenting with anemia were included in the study. Details clinical examination and blood tests namely mean corpuscular volume, red blood cell count, total leucocyte count, and platelet count were carried out from venous blood. Descriptive statistical analyses were conducted in STATA software version 15.1. Results: Among the total 150 anemic patients, the majority (126 [84%]) were in the 11-14 years of age group followed by 24 (16%) in 6-10 years of age (P < 0.0001). Girls were more (94 [62.7%]) than boys (56 [37.3%]), P < 0.0001. Anorexia was the most frequently encountered clinical symptom (99.3%) followed by pallor (94%), weakness (86%), fatigue (62%), and hyperpigmentation (37.4%). According to hemoglobin level, 40% were suffering from severe anemia, 38.7% was having moderate, and 21.3% was having mild anemia. The majority (74%) were having both Vitamin B12 and folic acid deficiency followed by 16.7% Vitamin B12, and 9.3% folic acid deficiency. Conclusion: Girls were presenting with megaloblastic anemia more than boys. Majority of them were suffering from both Vitamin B12 and folic acid deficiency. Children suffering from megaloblastic anemia present with anorexia, pallor, weakness, and fatigue. A proper health promotion program may be designed to aware the parents about the prevention of nutritional anemia.
Megaloblastic anaemia in Chinese patients: a review of 52 cases
1998
A prospective study of Chinese patients with megaloblastic anaemia was conducted at the Pamela Youde Nethersole Eastern Hospital from 1 May 1994 to 31 August 1997. Megaloblastic anaemia was diagnosed in 57 patients, 52 of whom were eligible for further evaluation. The median age of these 52 patients was 73.5 years and the male to female ratio was 1.08:1. The serum cobalamin level (median, 56 ng/L) was low in 46 (88.5%) patients. In five (9.6%) patients, both serum cobalamin and red blood cell folate concentrations were low. Isolated low red blood cell folate level was demonstrated in one (1.9%) patient. Serum antibodies against intrinsic factor and gastric parietal cells were detected in 32 (61.5%) and 26 (50.0%) patients, respectively; 19 (36.5%) patients had both types of antibody. The aetiology of megaloblastic anaemia included pernicious anaemia in 39 (75.0%) patients, postgastrectomy vitamin B 12 deficiency in five (9.6%) patients, and nutritional deficiency in two (3.8%) patients; the cause was undetermined in six (11.5%) patients. HKMJ 1998;4:269-74
International Journal of Research in Pharmaceutical Sciences
Megaloblastic anemia and Myelodysplastic syndrome are generally considered mutually exclusive diagnosis and at times becomes difficult to diagnose on the first encounter even after performing bone marrow examination. Aim of this study is to evaluate the role of LDH in the diagnosis of Megaloblastic anemia by treatment response at a tertiary care center in the northeastern part of India. Patients with age more than 12 years, Hemoglobin of patients less than 10 gm/dl, MCV ≥ 100 fl, Reticulocyte count <2.5 were included in the study. Based on serum LDH level patients were divided into two groups. Group A with serum LDH level ≥ 1200 U/L and Group B with serum LDH level of less than 1200 U/L. All these patients of serum LDH ≥1200 U/L were given a treatment trial of injectable Vitamin B12 containing 1000 μg of Vitamin B12 for 14 days. The response to treatment was monitored by an increment in reticulocyte count at day 5 and day 14. Bone marrow aspiration was done in all patients who ha...