Red cell indices for distinguishing macrocytosis of aplastic anaemia and megaloblastic anaemia.

Megaloblastic anaemia and aplastic anaemia are important causes of pancytopenia in India. Since both may have presence of macrocytes, peripheral smear examination alone may pose a difficulty in distinction between the two in the absence of macro-ovalocytes and hypersegmented neutrophils. The present study was conducted to evaluate the role of red cell indices in differentiation between macrocytosis of aplastic anaemia and megaloblastic anaemia. Haemogram from 25 cases each of biopsy proven megaloblastic anaemia and aplastic anaemia were reviewed. It was observed that MCV was greater than 97 fl in 15 cases of aplastic anemia (mean MCV 109.7 fl), and 25 cases of megaloblastic anaemia (mean MCV 113.2 fl). Hb, MCV & MCHC were comparable in the two groups. However, mean RDW in megaloblastic anaemia (mean 87.7 fl) was significantly higher than those in aplastic anaemia (mean 71.4 fl). The difference in RDW of patients with megaloblastic anaemia and aplastic anaemia was statistically significant. We conclude that RDW can be of help to differentiate between the two conditions.

Clinical, hematological and electrophysiologic study of megaloblastic anemias.

Thirty one cases of megaloblastic anaemia were studied clinically and electrophysiologically. Eight patients had clinical evidence of peripheral neuropathy. MNCV, distal sensory latency, la fibre conduction velocity, proximal conduction velocity and H-reflex amplitude and latency were compared with fourteen age and sex matched healthy controls. MNCV, proximal conduction velocity and H-reflex amplitude were significantly decreased in anaemic subjects while distal sensory latency was increased. No change was seen in la fibre conduction velocity and H-reflex latency. There was no correlation between severity of anaemia and the electrophysiologic abnormalities. MNCV and la fibre conduction velocity improved after correction of anemia.

Patterns of erythropoiesis and anaemia in malaria.

Of 138 patients with malaria, 90 were found to be having Plasmodium falciparum in their peripheral blood smears. Megaloblastosis alone or in combination with the other patterns of erythropoiesis was observed in 82.1 percent cases of chronic P. falciparum malaria as compared to 36.3 and 26.5 per cent cases of acute P. falciparum and P. vivax malaria respectively. Iron deficiency was observed in 15.5 percent cases of chronic P. falciparum, 18.2 per cent cases of acute P. falciparum and 13.3 per cent patients of P. vivax infection. Of patients with chronic falciparum malaria, 33.3 percent revealed features of both megaloblastosis and defective iron utilization and transient hypoplasia of marrow was observed in 8.9 per cent of these cases.

Anemia megaloblástica em idosos / Megaloblastic anemia in the elderly

Foram estudados retrospectivamente os prontuários de 20 pacientes idosos internados no Hospital das Clínicas da FMUSP, durante o período de 1974 a 1984, com diagnóstico de anemia megaloblástica. Dez doentes eram do sexo masculino e dez do feminino, com idades variando de 62 a 84 anos (média: 70,4 anos). Em todos os casos as manifestaçöes foram múltiplas e acentuadas, predominando as hematológicas, cardiocirculatórias, neurológicas, digestivas e o grave comprometimento do estado geral. Anemia com volume corpuscular médio elevado, aumento do índice de segmentaçäo dos neutrófilos, leucopenia, plaquetopenia e hemólise foram os achados hematológicos mais freqüentes, ocorrendo muitas vezes associadamente. Em todos os casos em que foi realizado o estudo endoscópico e a biópsia gástrica, encontraram-se alteraçöes. Näo houve diferença quanto às manifestaçöes entre os portadores de deficiência de vitamina B12 ou de ácido fólico. A resposta à terapêutica foi observada em 18 pacientes (90,0%) sendo, em geral, brilhante e rápida; porém, certas manifestaçöes neurológicas podem persistir. Por outro lado, os casos näo tratados podem até evoluir para óbito, em decorrência principalmente de complicaçöes cardiocirculatórias, hemorrágicas e infecciosas

Neutrophil function in megaloblastic anemia

Chemotaxis, nitroblue tetrazolium (NBT) reduction and the presence of Fcy receptors on surface membranes were in the peripheral blood neutrophils of 20 patients with megaloblastic anemia (15 with folate deficiency and 5 with pernicious anemia). The percent of NBT - or Fcy - positive neutrophils was the same for patients and normal controls. In contrast, chemotaxis was decreased - 20% (P < 0.05) in megaloblastic anemia and when anemia was correcred in 3 cases, chemotaxis increased to levels within the normal range. In contrast to wath one would expect on the basis of these laboratory findings, there are no reports of increased susceptibility to infections in these patients