Megaloblastic anaemia in hospitalised children.

Objective: To study the profile of megaloblastic anaemia in hospitalised children. Study design: Prospective study. Setting: Tertiary care hospital in Uttarakhand. Subjects: 53 children between 6 months and 14 years of age were studied for megaloblastic anaemia. Result: Majority of patients (48.8%) were in the older age group, and only 11% were seen in infancy. Folate and vit B12 deficiency was seen in 55% and 88% cases respectively. 44% had combined deficiency of folate and vitamin B12.11% had pure folate and 44% had pure vitamin B12 deficiency. 66% cases with microcytic blood picture, 70%with dimorphic picture, and 90% of pancytopenia patients on marrow examination had a megaloblastic picture. 60% had malnutrition, and majority belonged to the lower socio-economic strata of society.

Etiological profile of pancytopenia in adults in Marrakesh, Morocco

This retrospective study evaluated the frequency of different causes of pancytopenia in all adult patients with pancytopenia presenting to the Department of Haematology of Mohamed VI Hospital, Marrakesh from 1 January 2008 to 31 December 2010. A total of 118 cases of pancytopenia were found [average of 39 cases per year]. The mean age of patients was 52 years [range 18-82 years] and 52.5% were male. The main clinical signs were pallor [100%], asthenia [100%] and fever [30.5%]. Mean haemoglobin was 6.5 g/dL [range 2.9-9.2 g/dL], mean white blood cell count was 2360/mm[3] [range 840-3360/mm[3]] and platelet count 66 000/mm[3] [range 3000-123 000/mm[3]]. Bone marrow aspiration was performed in 112 patients; megaloblastosis was found in 32.2% and marrow blasts in 23.7%. Anaemia due to vitamin B[12] deficiency [32.2%], acute leukaemia [23.7%] and aplastic anaemia [15.2%] were the main causes of pancytopenia. Given the incidence of acute leukemia among our cases, patients presenting with pancytopenia require urgent diagnosis and treatment

Megaloblastic anemia: Back in focus.

Megaloblastic anemia (MA), in most instances in developing countries, results from deficiency of vitamin B12 or folic acid. Over the last two to three decades, incidence of MA seems to be increasing. Of the two micronutrients, folic acid deficiency contributed to MA in a large majority of cases. Now deficiency of B12 is far more common. In addition to anemia, occurrence of neutropenia and/or thrombocytopenia is increasingly being reported. Among cases presenting with pancytopenia, MA stands out as an important (commonest cause in some series) cause. This article focuses on these and certain other aspects of MA. Possible causes of increasing incidence of MA are discussed. Observations on other clinical features like neurocognitive dysfunction, associated hyperhomocysteinemeia and occurrence of tremors and thrombocytosis during treatment are highlighted.

Spectrum of anemia in pregnant Indian women and importance of antenatal screening.

Anemia is a common health problem but control of anemia in pregnant women is less well studied. The purpose was to study prevalence of anemia in young pregnant women, correlate with indices and study significance of identification of hemoglobinopathies. Of the 120 pregnant women, Hb was less than 8 g% in 58 (44.2%). Seventy-eight (65%) had iron deficiency, 22 (18.3%) had dimorphic anemia, and 14 (11.6%) had hemolytic anemia. Megaloblastic anemia was present in 6 (5%). Of hemolytic anemia, 50% were thalassemia trait. MCV< 76 fl was observed in 88 (73.3 %) cases. MCV<76 fl and MCH < 27 pg had 100 % sensitivity and 28.7 % specificity for screening of beta-thalassemia trait. NESTROFT had comparable sensitivity but lower specificity (14.9%). Sixty-three percent (60/78) of IDA had increased RDW whereas 78 % (11/14) of hemolytic anemia had RDW value in normal range (p value< 0.05). MCV/RBC of <14 was more specific parameter (96.8%) for beta-thalassemia trait. Four high-risk couples were identified. Thus, moderate to severe anemia was observed in most pregnant women. Hemoglobinopathies should be screened in antenatal clinics to identify the couples that would need a prenatal test. A lower MCV/RBC with RDWin the normal range may be useful in screening for thalassemia trait in pregnant women.

Anemia megaloblástica y manifestaciones gastrointestinales en Lima: ¿La punta del iceberg? / Megaloblastic anemia and gastrointestinal aspects in Lima: The tip of the iceberg?

Se revisa la casuística, de los tres últimos años, del servicio de Hematología y de un total de 316 casos se escogieron veinte que reúnen los criterios de inclusión (6.23%). Resultados: palidez y malestar en el 100%, alteraciones en el ritmo defecatorio 75%, náusea, vómito y sangrado en 40%, ictericia 25%, asco por los alimentos 20%, infección 10%. Anemia severa hiporregenerativa en el 100%, trombocitopenia 75% pancitopenia 60% como procesos asociados encontramos: antecedentes gineco-obstétricos en el 25%, tuberculosis entero-peritoneal 15%, y sin causa aparante el 40% primaria. En once pacientes se hicieron dosaje de Vitamina B12 y ácido fólico, encontrándose: déficit de B12 en 6 (54.5%), de ácido fólico en 3 (27.2%) y de ambos en dos (118.1%). Salvo un paciente que falleció en sepsis, los restantes respondieron adecuadamente al tratamiento vitamínico. Encontramos que la deficiencia de ácido fólico asociada a ferropenia, predominó en pacientes con antecedentes obstétricos; el déficit combinado, en aquellos con patología asociada y la falta de B12 en el grupo sin causa aparente. De la información nacional disponible y nuestra observaciones, podemos concluir que estamos frente a un brote de anemia megaloblástica que cursa frecuentemente con manifestaciones gastrointestinales y cuya causa aún no ha sido esclarecida