Evaluation of clinical, biochemical and hematological parameters in macrocytic anemia

Kannan, Aarthi; Tilak, Vijai; Rai, Madhukar; Gupta, Vibha

doi:10.18203/2320-6012.ijrms20161930

Cited by 9 publications

(13 citation statements)

References 17 publications

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“…Similar finding was observed by Daljinder Kaur et al, Pandya et al 17,16 Other studies observed female preponderance in megaloblastic anemia. 18,19 In the present study, the mean serum LDH level was found to be highest in megaloblastic anemia with LDH activity showing 19 times increase as compared to control.…”

Section: Discussionsupporting

confidence: 49%

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Utility of serum lactate dehydrogenase in the diagnosis of megaloblastic anemia

Gaikwad

Jadhav

2018

Int J Res Med Sci

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Background: Megaloblastc anemia corresponds to severe macrocytic anemia with hypersegmented neutrophils and very high serum Lactate Dehydrogenase (LDH). The present study was undertaken to evaluate the utility of serum LDH and chloroform inhibited serum LDH in the diagnosis of megaloblastic anemia and to observe if this can be used to differentiate megaloblastic anemia from iron deficiency anemia and hemolytic anemia.Methods: The present study was carried out on 75 patients of anemia categorised on bone marrow examination (into megaloblastic and non-megaloblastic anaemia) to evaluate the efficacy of total serum LDH levels and LDH isoenzyme pattern in the diagnosis of megaloblastic anemia. About 25 healthy adults were taken as controls.Results: In megaloblastic anemia, total serum LDH level was found to be increased to about nineteen folds and in hemolytic anemia it was found to increased four folds as compared to normal. On statistical analysis this increased total serum LDH level in megaloblastic anemia and hemolytic anemia as compared to control group was found to be significant.In the present study serum LDH level above 3000IU/L was associated with megaloblastic anemia and serum LDH level below 900IU/L was suggestive of iron deficiency anemia. The chloroform inhibition test was less than 25% in megaloblastic anemia and more than 25% in hemolytic anemia and these differences were found to be statistically significant (t=9.62, df=49, p<0.001).Conclusions: Total serum LDH levels more than 3000IU/L are diagnostic of megaloblastic anemia. Reversed LDH isoenzyme pattern (LDH1>LDH2) by chloroform inhibition test is an adjuvant in the diagnosis where total serum LDH levels are between 451-3000IU/L and can also differentiate megaloblastic anemia from hemolytic anemia.

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Section: Discussionsupporting

confidence: 49%

“…19 Stein D et al, found that the serum LDH level was significantly elevated, 1.3 to 24 times in megaloblastic anemia than normal. 20 Hess B et al, found increased serum LDH activity 5 to 21 times the normal in megaloblastic anemia.…”

Section: Discussionmentioning

confidence: 98%

Utility of serum lactate dehydrogenase in the diagnosis of megaloblastic anemia

Gaikwad

Jadhav

2018

Int J Res Med Sci

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“…So, a trial of vitamin B12 and folic acid therapy should be given before labelling a case as myelodysplasia. 21 With the advent of automated cell coulters, the red cell indices form an integral part of diagnosis. Abnormally high values of MCV are common, but their precise clinical significance may be difficult to establish.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of clinical, biochemical and hematological parameters in macrocytic anemia

et al. 2019

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Background: Macrocytosis can be seen in many hematological and non-hematological disorders and more than one cause may co-exist in an individual. Serum vitamin B12 and folic acid tests are routinely ordered but they are limited by their low sensitivity and specificity. This study is done to analyze the clinical, hematological and biochemical parameters in macrocytic anemia and to study the difference between megaloblastic and non-megaloblastic anemia in these parameters.Methods: There were 100 patients presenting with macrocytosis were taken in to study. A detailed clinical history and physical examination was done in all cases. CBC, biochemical investigations, peripheral blood examination, Vitamin B12, folate levels, bone marrow aspiration and reticulocyte count was done in all cases.Results: Primary bone marrow disorders were the most common cause of macrocytosis (45%). The other causes in decreasing order of frequency were megaloblastic anemia (36%), alcoholism and liver disease (15%), drug induced (2%) and idiopathic thrombocytopenic purpura (1%). There was a significant difference in the mean values of MCV and serum LDH between megaloblastic and non-megaloblastic macrocytosis. When serum LDH >1124.5IU/L or MCV>120.5fl (criterion values of ROC curve) with reticulocyte count <2% was taken as criteria, the sensitivity was 94.4% and specificity was 93% for diagnosing megaloblastic anemia.Conclusions: Systematic evaluation of macrocytosis will help us to distinguish megaloblastic and non-megaloblastic macrocytosis. The blood and biochemical parameters especially CBC, RC, and serum LDH along with supporting clinical features help us in diagnosing megaloblastic anemia in a setup where vitamin and metabolite levels are difficult to obtain.

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“…Megaloblastic anemia is a hematological disorder due to vitamin B 12 and folate deficiency. [1][2][3][4][5][6][7] It is characterized by impairment of the DNA synthesis in the bone marrow haematopoietic cells. [1][2][3][4][5][6][7] It is associated with macrocytic anemia and megaloblastic changes in the erythroid cells of the bone marrow.…”

Section: Introductionmentioning

confidence: 99%

“…2,6 The laboratory findings in patients of megaloblastic anemia include a raised mean corpuscular volume above 95 femtolitre. 7,12 Blood counts may show cytopenias i.e bicytopenia, pancytopenia or isolated anemia. 2 The levels of serum B 12 and folate are reduced in such patients.…”

Section: Introductionmentioning

confidence: 99%

Pattern of clinical and hematological profile in patients diagnosed as megaloblastic anemia in a tertiary care centre

Khan¹,

Munir²,

Fatima³

2019

TPMJ

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Objectives: To determine the pattern of clinical presentation, pattern of cytopenias, and haematological parameters of megaloblastic anemia in our setup. Study Design: Cross Sectional Descriptive study. Setting: Pathology Department, Khyber Teaching Hospital, Peshawar. Duration: January 2016 to December 2016 (one year period). Material and Methods: A total of 337 patients underwent bone marrow biopsy during the study period, out of which 46 patients were diagnosed as having megaloblastic anemia on bone marrow aspirate and B12 levels. The clinical features and hematological parameters of these patients were recorded in a proforma and the results were drawn accordingly. All cell counts were done on automated counter machine. Results: Out of 337 patients referred to pathology department for bone marrow aspiration, about 45 cases had megaloblastic anemia. These 45 cases were included in the study. Age of the study sample ranged from 1 year to 90 years (mean 32.2 years ± 12.1 SD). There were 35 (78%) males and 10 (22%) females, with male to female ratio of 3.5:1. Commonest clinical feature was generalized weakness and loose motion, while commonest physical sign was pallor, which were seen in 36 (80%), 36 (80%) and 40 (88%) cases respectively. About 28 (62%) patients had pancytopenia, 9 (20%) patients had bicytopenia (low hemoglobin and platelet count), and 8 (18%) cases had isolated anemia. Low Hb was present in all the 45 (100%) patients. Both the mean hemoglobin level and platelet count were reduced (7.4g/dL and 128x109/L. respectively) while mean white cell count in study sample was normal (mean 5.0x109/L). Conclusion: Megaloblastic anemia may presents as anemia, bicytopenia or pancytopenia. The cytopenias are important feature of megaloblastic anemia. Generalized weakness, and lethargy are the common clinical presentation, while pallor is common physical finding. Patients presenting with a constellation of generalized weakness, pallor and pancytopenia should be suspected of megaloblastic anemia and should be investigated accordingly.

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Evaluation of clinical, biochemical and hematological parameters in macrocytic anemia

Cited by 9 publications

References 17 publications

Utility of serum lactate dehydrogenase in the diagnosis of megaloblastic anemia

Utility of serum lactate dehydrogenase in the diagnosis of megaloblastic anemia

Evaluation of clinical, biochemical and hematological parameters in macrocytic anemia

Pattern of clinical and hematological profile in patients diagnosed as megaloblastic anemia in a tertiary care centre

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