CLINICAL AND EPIDEMIOLOGICAL PROFILE OF CHILDREN WITH MEGALOBLASTIC ANEMIA AT A TERTIARY CARE HOSPITAL IN WESTERN INDIA: A CROSS SECTIONAL STUDY

Background: In India most cases of Megaloblastic anemia are caused by nutritional deciency of vitamin B12 and Folic acid. Initial workup include Complete Blood Count(CBC), Peripheral blood smear(PBS) ,Vitamin B12 asssay, folic acid assay and Bone marrow if required. Therefore, this study is planned to study the clinical and laboratory prole of children with Megaloblastic anemia and to study the clinical outcome of children with Megaloblastic anemia Methods: The study was a prospective observational study conducted among 60 children with megaloblastic anemia, aged 1- 12 years. Demographic data, clinical symptoms and signs, laboratory ndings, serum B12 and Folic acid ,Bone marrow report and stool routine microscopy report were collected. Chi square test was applied. Results: Among the 60 children 40% were female sand 60% were males. The age of the study population ranged from a minimum of 1 month to a maximum of 12 years with a mean(SD) of 8.08 (± 5.45).Majority of children (41.6%) were in age group of 6 months- 1 year. Most common symptoms fever and most common sign is pallor. More than fty percent cases presented with severe anemia. Many cases reported late, leading to delay in diagnosis leads to poor outcome. Developmental delay (neurological manifestation) is strongly associated with vitamin B 12 deciency as compared to folic acid deciency. (p value <0.05) Conclusions: There is a slight female preponderance seen in megaloblastic anemia, probably due to reduced attention to girl children in the study group. neurological manifestation is strongly associated with vitamin B 12 deciency as compared to folic acid deciency.

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Study to evaluate the role of serum LDH in the diagnosis of Megaloblastic anemia by treatment response at a tertiary care center in the northeastern part of India

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v10i4.1573 ◽

2019 ◽

Vol 10 (4) ◽

pp. 2927-2935

Author(s):

Saurabh Chopra ◽

Lalit Prashant Meena ◽

Jaya Chakravarty ◽

Madhukar Rai

Keyword(s):

Bone Marrow ◽

Folic Acid ◽

Vitamin B12 ◽

Treatment Response ◽

Reticulocyte Count ◽

Megaloblastic Anemia ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center

Megaloblastic anemia and Myelodysplastic syndrome are generally considered mutually exclusive diagnosis and at times becomes difficult to diagnose on the first encounter even after performing bone marrow examination. Aim of this study is to evaluate the role of LDH in the diagnosis of Megaloblastic anemia by treatment response at a tertiary care center in the northeastern part of India. Patients with age more than 12 years, Hemoglobin of patients less than 10 gm/dl, MCV ≥ 100 fl, Reticulocyte count <2.5 were included in the study. Based on serum LDH level patients were divided into two groups. Group A with serum LDH level ≥ 1200 U/L and Group B with serum LDH level of less than 1200 U/L. All these patients of serum LDH ≥1200 U/L were given a treatment trial of injectable Vitamin B12 containing 1000 μg of Vitamin B12 for 14 days. The response to treatment was monitored by an increment in reticulocyte count at day 5 and day 14. Bone marrow aspiration was done in all patients who had serum LDH less than 1200 mg/dl. Seventy-nine consecutive patients, who presented with anemia (Hb<10 g/dl) and macrocytosis (MCV > 100 fl) were included in the study. Median LDH values were higher in the patients who responded ( vitamin B12 deficient megaloblastic anemia ) as compared to non-responders. 93.5% of patients with megaloblastic anemia had Vitamin B12 deficiency, and in comparison, the folic acid deficiency was present among just 6.5 percent patients. Serum Vitamin B 12 and Folic acid level should not be used as a sole criterion for the diagnosis of Megaloblastic anemia and other parameters such as MCV, LDH, and characteristic blood picture, should all be taken into consideration before planning an appropriate treatment strategy.

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A comparative study of bone marrow aspirate with trephine biopsy in pancytopenia disorders

IP Journal of Diagnostic Pathology and Oncology ◽

10.18231/j.jdpo.2021.043 ◽

2021 ◽

Vol 6 (3) ◽

pp. 201-206

Author(s):

Kavya J ◽

Kalpana Kumari MK

Keyword(s):

Bone Marrow ◽

Sensitivity And Specificity ◽

Megaloblastic Anemia ◽

Tertiary Care ◽

Bone Marrow Aspiration ◽

Bone Marrow Examination ◽

Care Hospital ◽

Trephine Biopsy ◽

Hematological Disorders ◽

Hematoxylin And Eosin

Pancytopenia is commonly reported in clinical hematology practice. Due to its varied marrow pathology and underlying ailments, diagnosis is often misleading and delayed. Bone marrow examination would provide a comprehensive diagnosis of both blood and bone marrow, since aspirate investigates the cytological morphology and biopsy evaluates the cellularity, architecture, and compact marrows.To compare bone marrow aspiration and trephine biopsy results in the diagnosis of pancytopenia, and to determine the sensitivity and specificity of aspirate examination in pancytopenia diagnosis.This prospective study was conducted at a tertiary care hospital from July 2014 to June 2016. A total of 320 samples were received at the department of pathology for bone marrow examination (aspirate and biopsy). Romanowsky (Leishman) stain was used to investigate aspirate samples. All biopsy samples were processed into 3-5 μ blocks and stained using hematoxylin and eosin after decalcification with 5.5% EDTA. Data analysis was performed using SPSS19.Pancytopenia constituted 56 (18.7%) cases with the mean age of 41.79 years. Of the total pancytopenia cases, hematological disorders constituted 50 (89.3%) cases and 6 (10.7%) were non-hematological cases. Aspirate and biopsy diagnosis positively correlated in 76.79% of cases. A 100% sensitivity and specificity of aspirate diagnosis was observed in, acute myeloid leukemia, hypersplenism, myelodysplastic syndrome, megaloblastic anemia, hematological malignancy in remission and negative for lymphoma infiltrate. Aspirate had no role in diagnosis of uremic osteodystrophy and myelofibrosis, whereas leishmaniasis was diagnosed on aspirate alone.Pancytopenia includes multiple underlying ailments which requires a differential diagnosis approach. Combining both aspirate and biopsy for diagnosis would benefit the patient in prognosis as they are complementary to each other.

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Congenital Familial Megaloblastic Anemia

Blood ◽

10.1182/blood.v37.6.615.615 ◽

1971 ◽

Vol 37 (6) ◽

pp. 615-623 ◽

Cited By ~ 9

Author(s):

BEATRICE C. LAMPKIN ◽

ALLAN PYESMANY ◽

CAROL B. HYMAN ◽

DENMAN HAMMOND

Keyword(s):

Bone Marrow ◽

Folic Acid ◽

Dna Synthesis ◽

Vitamin B12 ◽

Megaloblastic Anemia ◽

Vitamin Deficiency ◽

Preliminary Step ◽

Orotic Aciduria

Abstract Two sisters with a previously unreported megaloblastic anemia unassociated with a deficiency of either folic acid or vitamin B12 are described. Deficiencies of these vitamins were ruled out by standard studies. All other previously reported forms of megaloblastic anemia not secondary to a vitamin deficiency, such as orotic aciduria, were also excluded by appropriate studies. Optimal hemoglobin responses were obtained after the administration of large amounts of both vitamin B12 and folic acid. Because of this hemoglobin response, the conversion of deoxyuridine-5-monophosphate to deoxythymidine-5-monophosphate in vitro was examined in bone marrow samples from both patients using a modification of a method described by Killmann.18 This preliminary step in DNA synthesis was found to be normal. The results of this test and the optimal hemoglobin response after administration of both vitamins suggest that both folic acid and vitamin B12 may be necessary at some other preliminary step in DNA synthesis.

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Microspectrophotometric Determination of Desoxyribosenucleic Acid in Megaloblasts of Pernicious Anemia

Blood ◽

10.1182/blood.v6.4.344.344 ◽

1951 ◽

Vol 6 (4) ◽

pp. 344-349 ◽

Cited By ~ 10

Author(s):

EDWARD H. REISNER ◽

ROY KORSON

Keyword(s):

Bone Marrow ◽

Folic Acid ◽

Vitamin B12 ◽

Pernicious Anemia ◽

Blood Cells ◽

Nuclear Dna ◽

Liver Extract ◽

Megaloblastic Anemia ◽

Gradual Loss

Abstract 1. In 9 patients with various types of megaloblastic anemia responding to treatment with vitamin B12, folic acid or liver extract, no significant deviations from the normal amounts of total or polymerized DNA were observed in the nuclei of red blood cells in marrow smears. 2. During the maturation of megaloblasts in the bone marrow there is a gradual loss of nuclear DNA. 3. This pattern is quantitatively and qualitatively similar for normal marrow and for that of pernicious anemia in relapse and after treatment.

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Homocystinuria masquerading as vitamin B12 deficiency

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v4i2.6554 ◽

2012 ◽

Vol 4 (2) ◽

pp. 326-328

Author(s):

M Wadhwani ◽

S Beri ◽

A Saili ◽

S Garg

Keyword(s):

Vitamin B12 ◽

Megaloblastic Anemia ◽

Vitamin B12 Deficiency ◽

Interesting Case ◽

Vitamin B ◽

Ophthalmological Examination ◽

Ophthalmic Manifestations ◽

History Of ◽

B12 Deficiency ◽

Vitamin B 12

Background: Homocystinuria is a rare metabolic disorder charcterised by excess homocysteine in the urine. Vitamin B12 deficiency has diverse cutaneous, nervous and ophthalmic manifestations. Objective: To report a case of homocystinuria masquerading as vitamin B 12 deficiency. Case: We hereby are presenting an interesting case of a 4 year old boy who was being treated for Vitamin B 12 deficiency on the basis of history of delayed milestone, abdominal pain and hyperpigmentation of skin which was diagnosed as homocystinuria. Conclusion: It is important to carry out ophthalmological examination in every case of megaloblastic anemia if associated with blurring of vision and mental retardation.DOI: http://dx.doi.org/10.3126/nepjoph.v4i2.6554 Nepal J Ophthalmol 2012; 4 (8): 326-328

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Clinical and hematological profile of pancytopenia in a tertiary care hospital of Southern Odisha, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191333 ◽

2019 ◽

Vol 7 (4) ◽

pp. 1247

Author(s):

Namita Mohanty ◽

Arjun Nataraj Kannan ◽

Nikhil Jain

Keyword(s):

Bone Marrow ◽

Megaloblastic Anemia ◽

Tertiary Care ◽

Specific Treatment ◽

Vascular Diseases ◽

Care Hospital ◽

Collagen Vascular Diseases ◽

Common Causes ◽

Bone Marrow Study ◽

Physical Findings

Background: Pancytopenia (anemia, thrombocytopenia and leukopenia) is a common haematological condition with various etiologies like ineffective haematopoiesis, bone marrow suppression, bone marrow infiltration and peripheral destruction of blood cells. The present study was done to see the clinical features and etiologies of pancytopenia in this geographical region.Methods: About 150 patients above 15 years of age after fulfilling the inclusion criteria were included in the study. They were evaluated with appropriate laboratory tests including bone marrow study, if indicated to find out the underlying etiology.Results: Common symptoms were generalized weakness (93.3%), fever (75.3%) and dyspnoea (54%). Common physical findings were pallor (100%), lymphadenopathy (43.6%) and hepatosplenomegaly (32%). Most common causes were aplastic anemia (28%), megaloblastic anemia (20%) followed by infections like malaria (13.3%), dengue (5.3%) and sepsis (1.3%). Bone marrow was hypocellular in 50 patients (41.7%), hypercellular in 45 patients (37.5%) and normocellular in 25 patients (20.8%).Conclusions: There are some reversible causes of pancytopenia like megaloblastic anemia, malaria, dengue and sepsis. Conditions like disseminated Tb, collagen vascular diseases also can be treated with specific treatment if diagnosed early to avoid further complications.

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KNUCKLE HYPERPIGMENTATION AS A PRELIMINARY MARKER OF VITAMIN B 12 DEFICIENCY: A CASE SERIES

10.36106/paripex/1503416 ◽

2021 ◽

pp. 36-38

Author(s):

Manali Patil ◽

S. N. Agrawal ◽

V. V. Saoji

Keyword(s):

Vitamin B12 ◽

Megaloblastic Anemia ◽

Case Series ◽

Vitamin B12 Deficiency ◽

Neurological Deficits ◽

Vitamin B ◽

Important Clue ◽

B12 Deficiency ◽

Systemic Manifestations ◽

Vitamin B 12

Vitamin B12 deficiency is common in vegetarian population in India and can present with variable Hematological (megaloblastic anemia), Neuropsychiatric, Mucocutaneous (glossitis, angular stomatitis), Skin (pallor, hyperpigmentation) and Hair changes (dry, brittle, thin, lustreless, prematurely grey). Knuckle hyperpigmentation has been described in vitamin B12 deficiency but usually these patients are dermatologically asymptomatic but they have systemic manifestations like megaloblastic anemia, pancytopenia or neurological deficits. The foreground of this study is highlighting the importance of knuckle hyperpigmentation as an early cutaneous sign of vitamin B12 deficiency which points an important clue towards the aetiology of Megaloblastic anemia.

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Clinicohematological Study of Pancytopenia in a Tertiary Care Hospital of Western Region of Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.3265 ◽

2017 ◽

Vol 56 (207) ◽

pp. 319-324 ◽

Cited By ~ 1

Author(s):

Dilasma Ghartimagar ◽

Arnab Ghosh ◽

Sushma Thapa ◽

Deepa Sapkota ◽

Adarsh Kumar Jhunjhunwala ◽

...

Keyword(s):

Bone Marrow ◽

Megaloblastic Anemia ◽

Hematological Parameters ◽

Tertiary Care ◽

Bone Marrow Aspiration ◽

Metastatic Carcinoma ◽

Care Hospital ◽

Male Predominance ◽

Hypoplastic Marrow ◽

A Prospective Study

Introduction: Pancytopenia is a relatively common hematological entity and is a manifestation of many illnesses which can be life threatening at times. The severity of pancytopenia and the underlying pathology determine the management and prognosis. This study was conducted to evaluate hematological and bone marrow findings in patients presenting with pancytopenia. Methods: It was a prospective study carried out in Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal, during the period of January 2011 to December 2016. Clinical and hematological parameters including bone marrow aspiration and biopsy were evaluated in all patients who presented with pancytopenia. Results: Among 138 cases studied, patient’s age ranged from 2 to 82 years with a mean age of 43.95 years, and there was male predominance. Most of the patients presented with generalized weakness, pallor, dypnoea and fever. Hypoplastic marrow was seen in 38(27.5%) cases, followed by megaloblastic anemia 26 (18.8%) cases and acute leukemia 19(13.76%) cases. Other findings included one each case of hemophagocyosis, leishmaniasis, plasmodium vivex malaria and metastatic carcinoma. Conclusions: This study highlights that pancytopenia is a common hematological problem and the study of detailed primary hematological investigations along with bone marrow study in patients with pancytopenia will help to identify the cause for further planning and management. Keywords: hypoplastic marrow; leukemia; megaloblastic anemia; pancytopenia.

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Clinicohematological profile of pancytopenia: a study from a tertiary care hospital

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20200662 ◽

2020 ◽

Vol 7 (3) ◽

pp. 478

Author(s):

Rakesh Kumar Yadav ◽

Sujit Kumar

Keyword(s):

Vitamin B12 ◽

Tertiary Care Hospital ◽

Megaloblastic Anemia ◽

Tertiary Care ◽

Vitamin B12 Deficiency ◽

Clinical Feature ◽

Study Group ◽

Care Hospital ◽

Female Ratio ◽

B12 Deficiency

Background: Pancytopenia is common clinical condition which we encounter in our daily clinical practice. Pancytopenia is characterized by decrease in all the three major components of blood like Red Blood Corpuscles, White blood Corpuscle, and platelets. This study was carried out to look for causes of pancytopenia and clinical presentations at tertiary care hospital in north India.Methods: The study was conducted at MLN Medical College, Allahabad in the Department of Medicine between June 2018 to July 2019. Total 125 patients who attended department of medicine were screened for study. After exclusion 94 patients were studied prospectively.Results: Out of 94 patients 59 were males, and 35 females in the study group. Male to female ratio was 1.6:1. Maximum patients were between 20 years to 35years of age group. Pallor and weakness were most common clinical feature in this study group. Out of various etiological causes vitamin B12 deficiency was the commonest in our study. 48(51%) patients had megaloblastic anemia due to vitamin B12 deficiency. Second most common etiological factor was hypo plastic/aplastic anemia. Other etiological abnormalities were hypersplenism, dengue, malaria, sepsis, myelodysplastic syndrome and multiple myeloma.Conclusions: Bone marrow examinations, aspiration cytology or biopsy are important tool for diagnosis of pancytopenia. Underlying cause and severity of disease determine the outcome of pancytopenia. The present study concluded that most of patients with pancytopenia have treatable cause so early diagnosis will be helpful for management of patients.

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EVALUATION OF PANCYTOPENIA IN ADULTS PATIENTS OF BIHAR

10.36106/ijsr/2006035 ◽

2021 ◽

pp. 6-7

Author(s):

Rachana Rachana ◽

Nivedita Singh ◽

Om Prakash Diwedi

Keyword(s):

Bone Marrow ◽

Complete Blood Count ◽

Megaloblastic Anemia ◽

Tertiary Care ◽

Bone Marrow Aspiration ◽

Clinical History ◽

Bone Marrow Examination ◽

Underlying Disease ◽

Care Hospital ◽

Detailed Clinical History

INTRODUCTION– Pancytopenia usually indicates presence of serious underlying disease. Determining the etiology of pancytopenia is important for appropriate management of the patients. AIMS AND OBJECTIVES- This study was undertaken to identify the etiological factors leading to pancytopenia in a tertiary care hospital of Bihar. MATERIAL AND METHODS– This was a prospective study conducted over 12 months in the department of pathology, Nalanda medical college, Patna. The study included adult patients (>18yrs) who had pancytopenia in complete blood count. Relevant blood tests and bone marrow aspiration (BMA) and bone marrow biopsy (BMB) were done to delineate the etiology of pancytopenia. RESULTS– The commonest cause of pancytopenia in our study was aplastic anemia (46.67%) followed by megaloblastic anemia (23.33%) and hematological malignancies (acute leukemia and lymphoma- 15%). Other causes include infective diseases (kala-azar, malaria and tuberculosis), hypersplenism and hemophagocytosis. CONCLUSION- Determination of etiology of pancytopenia needs detailed clinical history and physical examination, and appropriate hematological tests and bone marrow examination.

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