Volume :4 | lssue: 12 | Dec 2014 I ISSN -2249-555X

Clinical & Haematological Profile of MegaloblasticAnemia- A RetrosPective StudY

Megaloblastic anemia is charac'terised by decreased haemoglobin level with elevated me4n corpqisc.ular

volltme (MCW1 ,2. Patients may present with general symptoms of anemia, sometimes neurological in-

vlolvement. De{iciency o{ v.itamin B 12 or folic acid which leads to impaired DNA synthesis gives rise to.macro^?fi:RBCs, ineffective erythropoiesrs & intramedullary haemolysisl ,2. This leads to rise in unconiugated billkubin, LDH &

also variable degree of cytopenias.

Aims & Objectives: To study.various symptoms, clinical {indings & haematological parameters of megaloblastic anemia-

Materials & methods: This was a retrospecl.ive observational type of study. The study was conduaed on patients admit-

ted in medicine department of SKN Medical College & Genergl HosPital, Pune .during_period.Jan 2a14 b Ocr2A14.

ih. .rr" records of 220 patients of anemia were reviewe.d & 3^0 ca^sgs o-{-megaloblastic anemia were selected for the

stLjdv- patients with diagnosis of megaloblastic anemia, Hb <10gm% & MCV 100f1 were se/ected for the study. Their

,..Jra, were reviewed. Data *ut cil[u.t d in terms of clinical findings & laboratory Parameters. .All cell counts were

Jii. ""

aulomated cou/ter' machine & peripherals smear reported by pathologist. Data was analysed using standard

statistical tests- Results are presented in form of tables & graphs-

Conclusion: Megaloblastic ariemia has wide clinical .& haematological.,spe.ctrum. lh.orough clinical assessment, good

ii.iiiiuii"n of "peripherat smear is vital for diaglosrs. Findings of pallor, icterus & leukopenia; thrombocytopenia are

commonly seen in o,ur rrrOt : '

cn. According to WHO anemia is defined as Hb < 13

"/ in males, Hb < 12 gm1" in females & Hb < 11 gm"/"

pregnant females3. Based upon RBC morphology.ane-

i isilassified as Normocytic, Microcytic & Macrocytic (or

Anemia is a common problem in our popu-

ic). Megaloblastlc anemia is characterised by

anisocytosis & poikilocytosis lvlCV in mega-

: anemia is ) 100 fl1-3. Causes of megaloblastic

are Vit. 812 or folic acid deficiency or abnormality

to therapy with vitamins & supportive care is generally- good2's.

Aims & Objectives: 1) To study various symptoms & clini-cal findings in patients of megaloblastic anemia- 2) To

study various haematological parameters in patients ofmegaloblastic anemia.

Materials & inethods: This was a retrosPective observa-

tional type of study. The study raras conducted on Patientsadmitted in medicine department of SKN Medical College& General Hospital, Pune during period Jan 2014 to Oct2014.The case records o{ 220 patients o{ anemia were re-

viewed & 30 cases o{ megaloblastic anemia were.selected

for the study. Since anemia is extremely common in ourprcpulation, we included patients with Hb < 10 9m7o.

lnclusion criteria: Patients with diagnosis of megaloblastic

anemia, HQ <1Ogm% & MCV ) toO fl.

Cases fulfilling above criteria were selected for the study.Their recordi were reviewed. Data was collected in termsof clinical findings & laboratory Parameters' All cell countswere done on automated coulter machine & peripheralssmedr reported by pathologist. Data was analysed usingstandard statistical tests. Results are Presented in {orm oftables & graph.

Results: The study consists of 30 patients of megalobla5ticanemia, Males & Females being equal in no. Male to fe-male ratio 1:1- The age varied from lowest 16 yrs to high-est 78 yrs. Mean age was 48.33* SD of 18.90. The agewise distribution is shown in graph l.

of their metabolism. lmportant clinical conditions leading

to megaloblastic anemia are recurrent diarrhoea, malab-

sorption syndromes, worms, Gl surgery nutritional - strict

vegans, chronic liver disease, drugs like methotrexate,

chemotherapeutic agents, anticonvulsants, proton pump

inhibitors, prolong antibiotic use, metformin, alcohol etc'

Vit. 812 & {olic acid are important for DNA & RNA syn-

thesisa. Their de{iciency causes ineffective erythroPoiesis &

intramedullary haemolysis- This ultimately results in mega-

loblastic changes. Other {eatures are variable degree ofleukopenia, thiombocytopenia, 3nd hypersegmented neu-

trophils on peripheral smear. Unconjugated billirubin & se-

rum LDH are ralsed. Bone marrow is usually hypercellular

with accumulation of primitive cellss' Patients usually pre-

sent with general symPtoms like shortness of breath' easy

fatigue, dJcreased appetite, weakness, oedema over feet'

On examination they have pallol sometimes glossitis' ic-

terus, hepato-splenomegaly or feature o{ congestive heart

failure. Small subset o{ patients have neurological involve-

ment due to demyelination. The neurological manifesta-

tions include peripheral neuropathy, ataxia, gait abnormal-ity, dementia & mental changes. The Patients should beinvestigated for sr- 812 & folic acid acid level. They usuallyrequire high doses of deficient vitamin or both. Response

MBBS, MD (MEDICINE), HOD OFMEDICINE, SMT. KASHIBAI NAVALE

MEDICAL COLLEGE & GENERALHOSPITAL, NARHE, PUNE.41 1041

MBBS, MD (MEDICINE), DEPT. OFMEDICINE, SMT. KASHIBAI NAVALE

MEDICAL COLLEGE & GENERALHOSPITAL, NARHE, PUNE-41'I 041

BBS, MD (MEDICINE), DEPT. OF

EDICINE, SMT. KASHIBAI NAVALE

MEDICAL COLLEGE & GENERALHOSPITAL, NARHE, PUNE.41 1041

INDIAN JOURNAL OF APPLIED RESE/qRCH E 67

EYWORDS , :

)R,-, i r.r

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Vofume : 4 | tssue : 1Z I DecZ014l ISSN _ 2249_S55XGraph l: Age wise distribution of study population Graph ll: Frequency of pancytopenia & bicytopenias inthe study:

AGE20

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Frequency of different clinrcal features in the study popula_tion rs shown in the table below.

Table l: Frequency of different clinical features:

Symptom No. Of cases Percentage (%)

3eneral Symptoms 73.33

Neurologicalrnvolvement o2 6.61

Pallor 30 100

Jaundice 10 aa a)

Hepatomegaly 07 23 33

Splenomegaly x7 23.33

tci80.70

60

lsodo

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20

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Lab. parameter No. Of cases Percentage (%)

Pa ncytopen ia 11 36.67

3icytopenia (anemia. leu-<openia)

1)CJ.JJ

Bicytopenia (anemia,throm bocytopen ia) 19 63.33

Feripheral smear examination showed low haemoglobinwith macrocytic RBCs along with anisocytosis a poi[ito.y-tosis., 13 (43.33%) patients had hypeisegmented poli-lTIh: ^""

.,T:.r; Leu.kopenia was seen ;, i: (+: riZ) purients_ Lowest leukocyte count in our study popularion was1800/cmm- Thrombocytopenia was seen'in iS (6:::Ztpatients. However none had reported signi{rcant

"b,norrn"jbleeding.contrasting to other studies. -

ll tli.ii\"l pa-tients had pancytopenia.Table lll: Various lab parameters in the study popula_tion:

t. ifti!t.r'. ! li

t8

16.- .-

1{,12

10

8

r AndIia & lsrkopenjir

I Alrenia Ithronbo(ytopffti.r

.: Pntr(ytopenia

Lab. parameter Mean

Hb 6.41 gm%

TLC 4987/cmmPlatelet count 1,53000/cmmMCV 115 ftST, LDH 2927.75

freque

METH15th (scriPti

RESUI\/ear5.

ths

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is a Precant e)

nary er

sometiafiectand mhYPertle{t veraPhYcardia& funries h:nale'1are a:effortsen tir

JlATIcondpita I ,

stu d.maleof st

lnc[AII r

the

Excl1. F

2.(3

General symptoms like easy fatigue, shortness of breath,oedema, weakness were present in 22 (13.33%) patients,.Pallor was present in all patients as in most of ti-re stud_ies. Clinical jaundice was seen in i,/3 study population.These patients had predominantly high unconjugated bil-lirubin indicating intramedullary haemoiysis. Hepatomegaly& splenomegaly was present in 07 (23.33o/o) patjents each.Neurological involvement was not common in our study,{ound in only 02 (6,67%) patients. These clinical find;njiare comparable other studies like Hirachand Sr, VineethaUnnikrishnan6 & Muhammad Bilal KhattakT

Distribution of various laboratory parameters is shourn infollowing graph. & tables.

Table ll: Frequenry of panqrtopenia & bicytopenias inthe study:

]Y.::l 1,"".:y]"?1" ,: the study popularion was surrerow (o.4 t qmyo). Ihis is probably because this is a tertiarycare hospital & only inpatients were included in the study.M31n MCV of all patients was l l5 {1. in the study conduct_ed by Hirachand 53 & oihers, the frequency oilytop"niu.was lower than our study where as Vineetha Unnikrishnanu& others reported more {requent cytopenias. MuhammadBilal Khattak? reported much higher occurrence of-prn.y_topenia, although mean values of Hb, leukocyte &'plate_let count were similar to our study. lnteresting finding inthe study was that mean sr. LDH was high _ a6out 5 to 6times the upper limit of normal. Out oitotal 30 patientssr. LDH was measured fbr 17 patients & it was elevated in15 patients (88%). Similar finding has been shbwn in otherstudiess.

Conclusion: Megaloblastic anemia has wide clinical & hae-matological spectrum. Thorough clinical assessment, goodexamination of peripheral smear is vital for diagnosis. Find-ings of pallor, icterus & leukopenia, thrombocftopenia arecommonly seen in our study.

l"*:,r5.rflfl:i5,3r1.#"13,Xii?;J"",[y:,::y*rj=l-1!ly wtlfls, rRrs DUGARTE and ADEfINA oJEDA "MesarobranicE7AnemjaofPregnancy:chaGderistic5ote".r,.g,l"Iu',;.;;;;",,;;T;"L,j".il},|xi#Xi"T'.i:f.1Ti:xl#i:3i;"y;#::r*;ltJii"l.!t.l;1ru:!,*l.f::?*"]l-y"",.d*Fll. Ili-!?t:iri,.",.gut",,"ir ."g.i"ui"=.,#?1._o".rHErANcEr.vor 34eiJanuatu1r 1ee7-,?,jxi*[..ai sirgi n, cr*,s ;r;,Ji;;;;;:"4;#;;#l*'ol!,;,'''u'us""nt ot I meqaloblastic anaemia". rHE tANcEr, Vol 34e'; January. ir ,, 1se7, 13 | 3.Marcolms. Druskin, M.D., Matuen H. warren, M,D.andLucasr"",",,,lil'i"t,T:-?1*1:,1]::l:1':.",'q,.maiof instituteof meliii*,rp{iora,ai,r, siazii.|:1[']T.:;3fr'"i,1;,yJ;;il::r# ];ffi?;li?;""T,![r',i;i",,,,t]ihl,irfflll,"-ffi':+i:',q,"ffi#il*:':lllr"ii'J','f ,1,i.'#rj;ForicAcidAdministered bvMouth Dairy", N e,sr.r;'r"JirZ)-,%;.;-s1,l6ils1a{'"ffi#:il'#;::i:::,T"?"rli.^?";[:3ffiffi;jff,;f,tf;i:1X?.T#llil:Hi:lt#*5#:l fllTi; 3l',filj,j. 8".'j; ;:,:'*::",1,f?P*[ 11[;i,"I:j1hr;:z,r:i:jiJiiosic pro,i re,or macroqric anemias uriih speia, rererence::.EE;il,i.TX^il"&i*it?ili"?il,"lli 3ff€*e#;,i1ni#;l:;i*,*mttfl*i:j.fr,* M":j:anti.:lr".ff;lg,j:#ir-i{tili,1.""j:?P5ll9lY!Yli ,I1/:b r',r.a.c^ar.muott,u"7fiiz.B"jie"i";-:jii;.;:;iJHc. Gupta y Sinsh M. sinsh s., "serum ractate der,ya,{oa;;;;;r;s,iJ;;I]s;i.fi1;*ll,li.;iii'i;J::"r;:lrffi,:::f,j.,r[lt:}ii,,j,ij#i

68 E INDIAN JOURNAL OF APPLIED RESEARCH