Relative Prevalence of Vitamin B12 and Folic Acid in Megaloblastic Anemia and Its Clinical – etiological Profile in a Tertiary Care Center

  • Praphull Deepankar1 Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
  • Rakesh Roshan Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India,
  • Harish Kumar Gupta PGIMER & Dr. Ram Manohar Lohia Hospital, N. Delhi, India
  • Gurdeep Buxi PGIMER & Dr. RamManohar Lohia Hospital, N. Delhi, India
Keywords: Anemia, Megaloblastic anemia, Pancytopenia, Serum B12, Serum folic acid

Abstract

Background: Megaloblastic anemia (MA) causes substantial morbidity in patients with anemia and increasing number of MA
is seen in clinical practice over the past 10–15 years.
Objectives: The objectives of the study were to study the relative prevalence of Vitamin B12 and folic acid (FA) in MA and its
clinical–etiological profile.
Methods: This is a cross-sectional observational study, conducted in the Department of Medicine, PGIMER and Dr. Ram Manohar
Lohia Hospital, New Delhi, with patients of MA in whom detailed history; physical examination and nutritional assessment were
recorded. Cobalamin and FA assays were done. Diagnosis of MA was confirmed by bone marrow aspiration and patients were
further investigated to find out its cause.
Results: Majority of studied patients (46%) were in age group 22–40 years with male: female ratio of 2.6:1. Majority cases (95%)
were from Hindu religion compared to Muslims (5%). The symptoms corresponding to anemia were the most common presentation
of the patient. Fatigueness was present in 92%, exertional dyspnea and palpitation were the presenting complaints in 59% and 19%
cases, respectively. Decrease appetite (80%), weight loss (54.6%), diarrhea (16%), mouth ulcer (14%), and paresthesias (11%)
were the other common presenting symptoms. Pallor (96%) was most common finding in the study group. Skin hyperpigmentation
was present in 48% and oral ulcer in 26% of patients. 54% of the participants had cobalamin deficiency, and 26% had FA deficiency,
and 21% had both. 37% of cases had the nutritional background. Among non-nutritional etiology most frequently associated factors
were alcohol and alcoholic liver disease (27%), and drugs (13%) followed by chronic infections and malabsorption.
Conclusion: The pathological conditions associated with the MA are much diverse. Proper diagnostic workup is essential
before the use of hematinics and blood transfusion in all anemic patients.

Author Biographies

Praphull Deepankar1, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Assistant Professor, Department of General Medicine, 

Rakesh Roshan, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India,

Senior Resident, Department of General Medicine, 

Harish Kumar Gupta, PGIMER & Dr. Ram Manohar Lohia Hospital, N. Delhi, India

Consultant and Head of Unit, Department of General Medicine, 

Gurdeep Buxi, PGIMER & Dr. RamManohar Lohia Hospital, N. Delhi, India

Professor, Department of Pathology

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Published
2018-06-14