VITAMIN DEFICIENCY AND FOOD SUPPLEMENTS

Vitamins are a heterogeneous group of organic compounds that help ensure the human bodys wellbeing and function. This paper introduces the importance of all vitamins, both water-soluble and fat-soluble, as well as problems deriving from their deficiency. Additionally, vitamin supplements as part of treating vitamin deficiency, and possible harmful effects on the human body areshowcased. The main focus of the paper is on the vitamin B complex, and vitamin B12 specifically. The benefits of vitamin B12, as well as its action in the human body and the noxious effects of any lack of vitamin B12 in the human body, are also discussed. Some of the health conditionsan individual may need to face when they have vitamin B12 deficiency include neural tube defects, Alzheimers disease, depression, and megaloblastic anaemia, which are also introduced and further discussed, in terms of symptomatology, causes and suggested treatment. The toxicity of vitamin B12 is also introduced, and possible causes for vitamin B12 deficiency are showcased.

Clinico–pathological spectrum of pancytopaenia

Pancytopaenia involves reduction in all the three haematological cell lines leading to the clinical manifestations related to anaemia, leucopaenia and thrombocytopaenia. These features can manifest either alone or in different combinations. Treatment depends on the accurate diagnosis for which pathological investigations are mandatory.The study was conducted with the aims and objectives of evaluating the different clinical and haematological parameters in cases presenting with pancytopaenia. Further, the cases were further divided based on their aetiology.A total of 64 cases were included in the present study. Detailed clinical, peripheral blood and bone marrow findings were studied.Majority of the patients belonged to the age group of 16-25 years. There was a slight female preponderance in our study in the ratio of 1:1.06 for M:F. The commonest clinical presentation was generalised weakness in 55 (85.9%) cases, followed by dyspnoea in 35 (54.7%) and fever in 30 (46.9%) patients. Pallor was the commonest examination finding observed in 60 (93.8%) cases followed by pedal edema in 19 (29.7%) patients. Among RBC morphology, normocytic normochromic picture was the commonest 18(28.1%), while bone marrow finding of erythroid hyperplasia with megaloblastic maturation was observed in 20 (31.2%) patients. Overall, megaloblastic anaemia was observed in 24 (37.5%) patients.Pancytopaenia is an important haematological manifestation in routine clinical practice. Timely, early and accurate diagnosis can save many morbidity and mortalities.

Imerslund-Grasbeck syndrome- a rare cause of megaloblastic anemia in an infant with homozygous mutation in CUBN gene: a case report and review of the literature

Megaloblastic anaemia is one of the important causes of pancytopenia in children and nutritional deficiencies of vitamin B12 and folate are the most common causes comprising 95% of these cases. Defects in absorption, transport and metabolism of vitamin B12 are well described, however, are very rare. We report a rare case of Imersland Grasbeck syndrome, in an infant who presented with pancytopenia, with defective absorption of B12-intrinsic factor complex at the ileum and defective tubular reabsorption of proteins in renal tubule due to same protein defect caused by mutations in two genes – CUBN (cubilin) and AMN (amnionless).

Clinico-Haematological Study of Pancytopenia – An Experience from a Tertiary Care Centre in Western Odisha

BACKGROUND Pancytopenia is a relatively common haematological entity with simultaneous presence of anaemia, leucopenia and thrombocytopenia. It is a feature of many medical and haematological disorders like megaloblastic anaemia, drug-induced bone marrow hypoplasia, even fatal leukaemia and bone marrow aplasia. The clinical and haematological studies determine the proper diagnosis and management of patients. Bone marrow examination is an important diagnostic procedure for determining the cause of pancytopenia. This study was conducted to evaluate clinico-haematological findings, identify the causes of pancytopenia, and compare our findings with other similar studies. METHODS The four-year retrospective study was carried out in the Department of Pathology at a tertiary care hospital in western Odisha, India. Data regarding clinical details, peripheral blood and bone marrow aspirations were collected and analyzed using simple statistical methods. RESULTS A total of 131 cases of pancytopenia were studied. The age range of patients was 3 years to 72 years, with a mean of 36.5 years. Male to female ratio was 0.84 : 1. The majority of cases were in the age group of 31 – 40 years (20.61 %). Generalized weakness with pallor (54.96 percent) was the commonest clinical finding, followed by splenomegaly (16.79 %), and hepatomegaly (11.45 %). Aplastic anaemia (43.51 %) was the most common cause found on the bone marrow aspiration followed by megaloblastic anaemia (22.14 %) and haematological malignancies. Among the haematological malignancies, acute myeloid leukaemia was the commonest cause of pancytopenia (10.69 %). CONCLUSIONS Bone marrow aspiration in cytopenic patients helps in understanding the disease process and to diagnose or rule out the causes of cytopenia. Different geographical areas have a different presentation of haematological disorders. KEYWORDS Bone Marrow Aspiration, Pancytopenia, Aplastic Anaemia

Haematological Evaluation in Patients of Pancytopenia by Bone Marrow Aspiration

BACKGROUND Pancytopenia is a reduction in all three major series of formed elements of blood i.e. erythrocytes, leucocytes and platelets. Pancytopenia is not an uncommon condition encountered in day to day clinical practice. The underlying aetiology of pancytopenia determines the management and prognosis of patients. Bone marrow aspiration is a minimally invasive, out-patient procedure which provides definitive diagnosis in a case of pancytopenia. In developing countries like India, the causes of pancytopenia are not well defined, hence, we conducted this study in Bundelkhand region of India to evaluate causes of pancytopenia. We wanted to evaluate haematological findings in patients of pancytopenia, and to study bone marrow findings by bone marrow aspiration to understand the underlying aetiology of pancytopenia. METHODS This prospective study was conducted in the Department of Pathology at MLB Medical College, Jhansi, among 65 patients over a one and a half year period from March 2018 to September 2019, to evaluate the causes of pancytopenia. RESULTS We found that out of 65 cases, 32 cases were of megaloblastic anaemia (49.23 %), 20 cases were of dimorphic anaemia (30.77 %), 6 cases were of hypersplenism (9.23 %), 4 cases were of subleukemic leukemia (6.15 %), 2 cases of aplastic anaemia (3.7 %) and 1 case was of myelodysplastic syndrome (1.54 %). CONCLUSIONS Along with detailed clinical examination and complete blood count, bone marrow examination is indispensable to diagnose the aetiology of pancytopenia, thereby helping clinician in planning management of these patients. KEY WORDS Pancytopenia, Megaloblastic Anaemia, Dimorphic Anaemia, Bone Marrow Examination

Clinicohaematological & Aetiological Profile of Bicytopenic / Pancytopenic Children in Dehradun, India - A 5-Year Study

BACKGROUND Cytopenia (bicytopenia / pancytopenia) in paediatric age group patients presents with variable clinical features from pallor, fever to organomegaly. Causes vary from megaloblastic anaemia to fatal leukaemias. The purpose of the study was to evaluate the etiological and clinico-haematological profile in children with bicytopenia and pancytopenia. METHODS The present retrospective study was carried out in the section of haematology, Department of Pathology of Shri Guru Ram Rai Institute of Health and Medical Sciences, Dehradun. All paediatric cases (up to 18 yrs.) with bone marrow examination, that were presented as bicytopenia or pancytopenia by routine haematological investigations were included in the study. RESULTS A total of 126 cases were included in the study, out of which, bone marrow aspiration was done in all 126 cases and trephine biopsy was done in only 78 cases. In our study, bicytopenia and pancytopenia was seen in 57.9 % and 42.1 % cases respectively. Most cases were recorded in 2nd decade. Pallor and fever were frequently observed clinical features in both cytopenias. Splenomegaly, lymphadenopathy and hepatomegaly were observed more in bicytopenia (34.2 %, 28.8 % and 27.4 % respectively). Bleeding and petechial rash were more common in pancytopenia (30.2 % and 20.8 % respectively). Anaemia and thrombocytopenia (67.1 %) were commonest combinations of bicytopenia followed by anaemia and leucopenia (26.0 %) and thrombocytopenia and leucopenia (6.8 %). CONCLUSIONS Bone marrow aspiration and trephine biopsy are important diagnostic tools in evaluating the cases of cytopenia. Both procedures are complementary to each other. KEY WORDS Bicytopenia, Pancytopenia, Megaloblastic Anaemia, Leukemia, Children

CLINICO HEMATOLOGICAL PROFILE OF PATIENTS WITH PANCYTOPENIA- A THREE-YEAR STUDY

Background: Pancytopenia is a relatively common hematological entity. It may result from relatively benign causes such as viral infections and vitamin B12/folic acid deciency to more fatal bone marrow aplasia and leukaemias. The severity of pancytopenia and the underlying pathology determine the management and prognosis. Objectives: To study the etiology and clinic-hematological prole in patients of peripheral blood pancytopenia. Materials And Methods: This was a retrospective study conducted at G S Medical College, Hapur and Noida international institute of Medical Sciences Greater Noida, during the period of November 2017 to November 2020 Results: A total of 192 patients (103 males and 89 females) were diagnosed to have pancytopenia. Most of the patients presented with generalized weakness and fever. The commonest physical nding was pallor, followed by splenomegaly. The various causes of pancytopenia included infections(n=132), megaloblastic anaemia (MA)(n=46), drugs, aplastic anaemia and subleukaemic leukaemia. We found a signicant association between megaloblastic anaemia and pancytopenia. Conclusion: The present study concluded that infection and megaloblastic anaemia are the most common cause of pancytopenia. The more serious disorders affecting the bone marrow constitute only <5% of all cases of pancytopenia.

Tongue disorders due to megaloblastic anaemia and its management: A case report.

The presence of megaloblasts and macrocytes in the bone marrow characterizes megaloblastic anaemia. Megaloblastic anaemia is the result of folate and vitamin B12 deficiency in more than 95% of cases. We hereby report a case of megaloblastic anaemia in a 23-year old female having glossitis and a burning sensation on the tongue. The blood picture showed megaloblastic anaemia and haematological tests confirmed the diagnosis. The patient positively responded to vitamin B12 and folic acid supplementation. The presence of oral signs and symptoms offer the dentist an opportunity to participate in the diagnosis of this condition. Early diagnosis is important to prevent deficiency. This paper explains the oral changes induced by dietary deficiency of cobalamin or folate in a patient with megaloblastic anaemia. Update Dent. Coll. j: 2021; 11 (1): 26-28