Megaloblastic Anemia Presenting with Massive Reversible Splenomegaly

Abstract

Megaloblastic anemia (MA) is a common disorder with varied manifestations. It generally results in mild to moderate splenomegaly which is due to sequestration of macrocytic erythrocytes in spleen. Massive splenomegaly is generally seen in infections, myeloproliferative diseases, neoplasms, storage disorders or hematological conditions; but is not heard of and has rarely been reported in MA. We discuss a case of massive splenomegaly who presented with symptomatic anemia and was found to have MA. He was extensive evaluated for all other causes of massive splenomegaly which was normal. Further, after a therapeutic trial of MA he showed a regression in spleen size confirming that the massive splenomegaly was attributable to MA.

Massive Splenomegaly: A Rare Presentation of Megaloblastic Anemia

“…Halfdanarson et al 12 described a 46-year-old woman with severe pancytopenia who had massive splenomegaly and the spleen size reduced after treatment of megaloblastic anemia. In another case reported by Behera et al ., 14 there were some similar cases with massive spleen due to megaloblastic anemia in a 32-year-old man whose spleen size regressed after vitamin B12 deficiency treatment. Additionally, two infants with severe vitamin B12 deficiency and hepatosplenomegaly and pancytopenia manifestation were recently reported 13 .…”

“…One of the known presentations of megaloblastic anemia is splenomegaly, which can occur due to detaining of large number of macrocytic RBCs 6 . Size of spleen in megaloblastic anemia-induced splenomegaly is usually between 3 to 14 cm, which is considered mild to moderate 11 , while massive splenomegaly is rarely seen in megaloblastic anemia and it was noted in only few literatures 12 - 14 . Halfdanarson et al 12 described a 46-year-old woman with severe pancytopenia who had massive splenomegaly and the spleen size reduced after treatment of megaloblastic anemia.…”

An Unusual Presentation of Vitamin B12 Deficiency Associated With Massive Splenomegaly, Hemolytic Anemia, and Pancytopenia: A Case Report

“…Megaloblastic anaemia is a condition in which the bone marrow produces abnormally large, structurally abnormal erythrocytes (megaloblasts) [ 16 ]. The bone marrow, a soft spongy substance found inside some bones, produces the body's main blood cells, white cells, red cells, and platelets.…”

Splenomegaly in a Patient with a History of Pernicious Anemia; the Potential Therapeutic Effects of B12 Therapy

“…As well as, serial abdominal ultrasounds showed gradual decreases in splenic size. A regression of 2 cm after 6 months was reported [ 1 ]. Our patient began to show signs of recovery of his blood counts within 3-4 weeks of parenteral vitamin B12 supplementation.…”

“…Splenomegaly due to exacerbated forms of normal splenic function is common in conditions such as infection, autoimmune disease, liver disease, leukemia, and hemolytic anemia. The spleen has multiple functions; it is involved with hematopoiesis, immunity, and filtering old, malformed, or damaged red blood cells [ 1 ]. An increase in red blood cell surface area, as in the case of macrocytic anemia, causes congestion of the splenic vasculature, potentiating pancytopenia.…”