Clinico-aetiologic profile of macrocytic anemias with special reference to megaloblastic anemia

Abstract

Purpose of study This study was conducted to study the clinical and laboratory parameters in patients with macrocytic anemia and to determine the etiology of macrocytic anemia with special reference to megaloblastic anemia. Materials and methodsThis study was a cross-sectional descriptive study carried over a period of 18 months on 60 adult patients (age ≥13 years) of macrocytic anemia. Macrocytic anemia was identifi ed when peripheral blood examination showed anemia with a mean red blood corpuscular volume of >95 fl .Result The most common cause of macrocytic anemia was megaloblastic anemia (38.4%). The major causes of nonmegaloblastic macrocytic anemia were primary bone marrow disorders (35%), liver diseases (15%) and hemolytic anemia (8.3%). There was a signifi cant male preponderance in the study (65%). The megaloblastic anemias observed were due to either vitamin B 12 defi ciency (78.3%) or combined B 12 and folate defi ciency (21.7%). A signifi cant proportion of non-vegetarians (73.9%) had megaloblastic anemia.Patients with an MCV of >110fl were more likely to have megaloblastic anemia (p value 0.0007). Three patients (mean age 55 years) with a megaloblastic marrow did not respond to vitamin replacement and were found to have myelodysplastic syndrome.Conclusion Megaloblastic anemia due to Vitamin B 12 or folate defi ciency remains the most important cause of macrocytic anemia. In settings with limited laboratory facilities, a therapeutic trial of vitamins B 12 or folic acid is useful in determining the specifi c vitamin defi ciency.

Tropical sprue in megaloblastic anemia

“…In concordance with present study, Unnikrishnan et al, and Iqbal et al, also reported a higher proportion of non-vegetarians having megaloblastic anemia and Vitamin B12 deficiency. 7,8 In contrast to our finding, Liggy et al and Kankonkar et al, showed Vitamin B12 deficiency higher in vegetarians than non-vegetarian. But the study cohort was different, Liggy et al, included all the patients and not only anemic patients, Kankonkar studied B12 deficiency in different diseases.…”

“…Unnikrishnan et al, found 91.7% of their patients presenting with fatigability, but in contrast to present study, 36.7% had bleeding manifestation and 10% presented with neurological symptoms. 7 In another study by Haq et al, in a population of 80 patients, 84% had fatigability and 27.5% had bleeding tendency. 6 Bleeding manifestations in thrombocytopenia due to Vitamin B12 or folate deficiency are typically mild and this may be the reason why no patient presented with bleeding tendency in the study.…”

Evaluation of clinical, biochemical and hematological parameters in macrocytic anemia

“…Drug therapy, Vitamin B12 and folate deficiency, alcohol abuse were described as common causes of macrocytosis. 4,5,[9][10][11][12] But, in present study primary bone marrow disorders was the most common cause. This variation might be due to the difference in the selective criteria (Mcphedran et al [9] used MCV>115fl, Unnikrishnan et al used MCV>95fl) used along with varied environmental and demographic factors.…”

105 Cases of Macrocytosis- Etiologic Profile Reflecting Lifestyle Changes

“…Another study done at Puducherry, India reported megaloblastic anemia as the most common cause of macrocytosis . [2] This disparity may reflect the lifestyle changes in Kerala State where while the literacy rate is high, the alcohol consumption is highest among all Indian states. The government owned Kerala State Beverages Corporation holds monopoly over liquor sales in the state.…”

“…[1] Nutritional megaloblastic anemia is very important in the Indian scenario. [2] However non megaloblastic macrocytosis also forms an important group which includes alcoholic liver disease, hemolytic anemias, leukemias etc. Kerala is a an Indian State where literacy rate is high.…”