Hematological Changes in Megaloblastic anemia: A study of 25 cases

Vijay Kumar Sinha, Subhash Chandra Jha, Parshuram Prasad, Dilip Kumar Pandey

Abstract


Materials and Methods: A teaching hospital-based retrospective study was done for a period of 1 year.
25 cases of megaloblastic anemia were analyzed and we correlated signs, symptoms, and
hematological investigations.
Results: Totally, 25 patients with megaloblastic anemia in the above said period were studied. The patient's age group was
ranged from 12 years to 87 years .Male female ratio was 4:1. Megaloblastic anemia was observed in all the cases. Pancytopenia
was seen in all cases. 25 patients had isolated vitamin B12 deciency. 3 patients had both Folic acid and vitamin B12 deciency.
One had only isolated Folic acid deciency.
Conclusion: Megaloblastic anemia is one of the common causes of undiagnosed anemia, and the treatment is simple and
easily affordable. If left untreated, it can lead to morbidity both because of anemia and attendant neurological involvement.


Keywords


Megaloblastic anemia, Vitamin B12, Folic Acid, Pancytopenia

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Chanarin I, Metz J. Diagnosis of cobalamin deficiency: the old and new. Br J Haematol 1997;97:695–700. [PubMed] [Google Scholar]

Davidson RJ, Hamilton PJ. High mean red cell volume: its incidence and significance in routine haematology. J Clin Pathol 1978;31:493–498. [PMC free article] [PubMed] [Google Scholar]

Hattersley PG, Gerard PW, Caggiano V, Nash DR. Erroneous values on the Model S Coulter Counter due to high titer cold autoagglutinins. Am J Clin Pathol 1971;55:442–446. [PubMed] [Google Scholar]

Lindenbaum J. Status of laboratory testing in the diagnosis of megaloblastic anemia. Blood 1983;61:624–627. [PubMed] [Google Scholar]

Lawrence AC, Bevington JM, Young M. Storage of blood and the mean corpuscular volume. J Clin Pathol 1975;28:345–349. [PMC free article] [PubMed] [Google Scholar]

Breedveld FC, Bieger R, van Wermeskerken RK. The clinical significance of macrocytosis. Acta Med Scand 1981;209:319–322. [PubMed] [Google Scholar]

Colon-Otero G, Menke D, Hook CC. A practical approach to the differential diagnosis and evaluation of the adult patient with macrocytic anemia. Med Clin North Am 1992;76:581–597. [PubMed] [Google Scholar]

Savage DG, Ogundipe A, Allen RH, Stabler SP, Lindenbaum J. Etiology and diagnostic evaluation of macrocytosis. Am J Med Sci 2000;319:343–352. [PubMed] [Google Scholar]

Nathan DG, Orkin SH, Look AT, Ginsburg D. Nathan and Oski’s hematology of infancy and childhood. 6th ed. Philadelphia: Saunders; 2003; 1841.

Hoffbrand V, Provan D. ABC of clinical haematology. Macrocytic anaemias. BMJ 1997;314:430–433. [PMC free article] [PubMed] [Google Scholar]

Sechi LA, De Carli S, Catena C, Zingaro L, Bartoli E. Benign familial macrocytosis. Clin Lab Haematol 1996;18:41–43. [PubMed] [Google Scholar]

Thomas CW Jr, Lowry PW, Franklin CL, Weaver AL, Myhre GM, Mays DC, Tremaine WJ, Lipsky JJ, Sandborn WJ. Erythrocyte mean corpuscular volume as a surrogate marker for 6-thioguanine nucleotide concentration monitoring in patients with inflammatory bowel disease treated with azathioprine or 6-mercaptopurine. Inflamm Bowel Dis 2003;9:237–245. [PubMed] [Google Scholar]

Petersen K, Hale BR, Wallace MR. Macrocytosis after nucleoside-containing HIV treatment regimens. Infect Dis Clin Pract 2005;13:65–67. [Google Scholar]

Steele RH, Keogh GL, Quin J, Fernando SL, Stojkova V. Mean cell volume (MCV) changes in HIV-positive patients taking nucleoside reverse transcriptase inhibitors (NRTIs): a surrogate marker for adherence. Int J STD AIDS 2002;13:748–754. [PubMed] [Google Scholar]

Bain BJ. Diagnosis from the blood smear. N Engl J Med 2005;353:498–507. [PubMed] [Google Scholar]

Torres Gomez A, Casano J, Sanchez J, Madrigal E, Blanco F, Alvarez MA. Utility of reticulocyte maturation parameters in the differential diagnosis of macrocytic anemias. Clin Lab Haematol 2003;25:283–288. [PubMed] [Google Scholar]

Hoffman R, Benz EJ Jr, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlave P, eds. Hematology: basic principles and practice. 4th ed. New York, NY: Churchill Livingston; 2005.

Hoffman R, Benz EJ Jr, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlave P, eds. Hematology: basic principles and practice. 2nd ed. New York, NY: Churchill Livingston; 1995. 562–563.

Ward PC. Modern approaches to the investigation of vitamin B12 deficiency. Clin Lab Med 2002;22:435–445. [PubMed] [Google Scholar]

Snow CF. Laboratory diagnosis of vitamin B12 and folate deficiency: a guide for the primary care physician. Arch Intern Med 1999;159:1289–1298. [PubMed] [Google Scholar]

Andres E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, Noblet-Dick M, Maloisel F, Schlienger JL, Blickle JF. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ 2004;3:251–259. [PMC free article] [PubMed] [Google Scholar]

Oh RC, Brown DL. Vitamin B12 deficiency. Am Fam Physician 2003;67:979–986. [PubMed] [Google Scholar]

Chanarin I. The megaloblastic anaemias. 2nd ed. Oxford, England: Blackwell Scientific Publishers; 1979.

Handin RI, Lux SE, Stossel TP. Blood: principles and practice of hematology. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1995; 1406.

Lindenbaum J, Allen RH. Clinical spectrum and diagnosis of folate deficiency. In: Bailey LB, ed. Folate in health and disease. New York, NY: Marcel Dekker; 1995. 43–73.

Antony AC. Megaloblastic anemias. In: Hoffman R, Benz EJ Jr, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlave P, eds. Hematology: basic principles and practice. 3rd ed. New York, NY: Churchill Livingston; 2000. 446–485.

Jaffe JP, Schilling RF. Erythrocyte folate levels: a clinical study. Am J Hematol 1991;36:116–121. [PubMed] [Google Scholar]

Barney-Stallings RA, Heslop D. What is the clinical utility of obtaining a folate level in patients with macrocytosis or anemia? J Fam Pract 2001;50:544. [PubMed] [Google Scholar]

Lee GR, Foerster J, Lukens J, Paraskevas F, Greer JP, Rodgers GM, eds. Wintrobe’s clinical hematology. 10th ed. Baltimore: Williams & Wilkins; 1999.

Tisman G, Herbert V. B12 dependence of cell uptake of serum folate: an explanation for high serum folate and cell folate depletion in B12 deficiency. Blood 1973;41:465–469. [PubMed] [Google Scholar]

Stabler SP, Marcell PD, Podell ER, Allen RH, Savage DG, Lindenbaum J. Elevation of total homocysteine in the serum of patients with cobalamin or folate deficiency detected by capillary gas chromatography-mass spectrometry. J Clin Invest 1988;81:466–474. [PMC free article] [PubMed] [Google Scholar]

Allen RH, Stabler SP, Savage DG, Lindenbaum J. Diagnosis of cobalamin deficiency I: usefulness of serum methylmalonic acid and total homocysteine concentrations. Am J Hematol 1990;34:90–98. [PubMed] [Google Scholar]

Lindenbaum J, Savage DG, Stabler SP, Allen RH. Diagnosis of cobalamine deficiency: II. Relative sensitivities of serum cobalamine, methylmalonic acid, and total homocysteine concentrations. Am J Hematol 1990;34:99–107. [PubMed] [Google Scholar]

Savage DG, Lindenbaum J, Stabler SP, Allen RH. Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med 1994;96:239–246. [PubMed] [Google Scholar]

]

Lloyd-Wright Z, Hvas A, Moller J, Sanders TA, Nexo E. Holotranscobalamin as an indicator of dietary vitamin B12 deficiency. Clin Chem 2003;49:2076–2078. [PubMed] [Google Scholar]

Nilsson K, Isaksson A, Gustafson L, Hultberg B. Clinical utility of serum holotranscobalamin as a marker of cobalamin status in elderly patients with neuropsychiatric symptoms. Clin Chem Lab Med 2004;42:637–643. [PubMed] [Google Scholar]

Solomon LR. Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing. Blood 2005;105:978–985. [PubMed] [Google Scholar]

Robinson AR, Mladenovic J. Lack of clinical utility of folate levels in the evaluation of macrocytosis or anemia. Am J Med 2001;110:88–90. [PubMed] [Google Scholar]

Nyholm E, Turpin P, Swain D, Cunningham B, Daly S, Nightingale P, Fegan C. Oral vitamin B12 can change our practice. Postgrad Med J 2003;79:218–220. [PMC free article] [PubMed] [Google Scholar]

Bolaman Z, Kadikoylu G, Yukselen V, Yavasoglu I, Barutca S, Senturk T. Oral versus intramuscular cobalamin treatment in megaloblastic anemia: a single-center, prospective, randomized, open-label study. Clin Ther 2003;25:3124–3134. [PubMed] [Google Scholar]

Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J. Effective treatment of cobalamin deficiency with oral cobalamin. Blood 1998;92:1191–1198. [PubMed] [Google Scholar]

Sharabi A, Cohen E, Sulkes J, Garty M. Replacement therapy for vitamin B12 deficiency: comparison between the sublingual and oral route. Br J Clin Pharmacol 2003;56:635–638. [PMC free article] [PubMed] [Google Scholar]


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