|Year : 2022 | Volume
| Issue : 2 | Page : 141-144
Prevalence of megaloblastic anaemia and its causative factors in a tertiary care centre at Western India
Atul Khajuria1, Rakesh Das2
1 Department of Medical Laboratory Technology, NIMS College of Paramedical Technology, NIMS University, Jaipur, Rajasthan, India
2 Technical Officer Medical Laboratory Technology, NIMS College of Paramedical Technology, Jaipur, Rajasthan, India
|Date of Submission||25-Nov-2022|
|Date of Decision||28-Nov-2022|
|Date of Acceptance||29-Nov-2022|
|Date of Web Publication||11-Jan-2023|
NIMS College of Paramedical Technology, NIMS University, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: Anaemia affected population includes male, females as well as children and is a common problem that has been seen in western India. Megaloblastic Anaemia is common in India but regarding its prevalence and causative factors data is insufficient. The most common cause of megaloblastic anaemia includes deficiency of folic acid and Vitamin B12. Due to vegetarian lifestyle of the people the deficiency of Vitamin B12 is more common rather than the other macronutrient. In today's time, only iron and folic acid is provided by Anaemia control or prophylaxis program. This issue needs focus and hence this study has been chosen.
Objective: To focus on the incidences of Megaloblastic Anaemia in Western India and analyse the possible causative factors.
Materials and Methods: Patients with a haemoglobin <10 g/dl and peripheral smear findings consistent with megaloblastic anaemia present in the hospital over a period of 2 months will be included in the study. Patient's diet, drug intake, present symptoms and other history will be taken into account. Recording of complete blood counts, peripheral film examination, reticulocyte count and cobalamin and folate assays will be done. Patients suffering from chronic disease like renal disease, cancer, tuberculosis, liver disease etc., Will be excluded from the study. All data will be collected and statistically evaluated.
Results: In the current study, 500 patients who were admitted to the gynaecology, paediatric, and medical wards were all assessed. These patients were all eligible to participate. They were divided into three groups based on the mean corpuscular volume (MCV) value, serum assay, and peripheral smear results: Macrocytic, normocytic, and microcytic anaemia. A megaloblastic blood film or low serum indicators along with the normal MCV value were categorised as having macrocytic anaemia. A total of 100 patients had macrocytic anaemia identified. The distribution of sexes was: 70 (male), 30 (female). There were discovered to be 55% of patients with cobalamin deficit and 8% of patients with folate deficiency. Every patient were vegetarians, coming from a poor socioeconomic status.
Conclusion: The diagnosis of Megaloblastic anaemia was done through complete blood counts, red cells and assays of two vitamins. Majority of patients having megaloblastic anaemia was due to deficiency of cobalamin. Poor diet in cobalamin or folate were the contributing factors in Megaloblastic anaemia. Prevention can be done through awareness camps and education programmes and also through proper diet. Vitamin B12 should be included in the diet of patients along with iron and folic acid.
Keywords: Folic acid, haemoglobin, macrocytic, microcytic, normocytic, Vitamin B12
|How to cite this article:|
Khajuria A, Das R. Prevalence of megaloblastic anaemia and its causative factors in a tertiary care centre at Western India. Santosh Univ J Health Sci 2022;8:141-4
|How to cite this URL:|
Khajuria A, Das R. Prevalence of megaloblastic anaemia and its causative factors in a tertiary care centre at Western India. Santosh Univ J Health Sci [serial online] 2022 [cited 2023 Jan 28];8:141-4. Available from: http://www.sujhs.org/text.asp?2022/8/2/141/367576
| Introduction|| |
India is country with diverse population different food habits and sociocultural norms. The problem of Megaloblastic anaemia has not properly been recorded. From the public health point of view deficiency of Vitamin B12 and folate has added a little to nutritional Anaemia. Various workers has presented this issue but of no use. This study has been choosen to focus on this issue.
In Western India the most common problem encountered is Anaemia. Thomas Addison in 1849 atrributed the first clinical description of pernicious Anaemia which is one of the known cause of Megaloblastic anaemia. Megaloblastic anaemia s caused due the abnormal maturation of haematopoietic cells due to the fault in DNA synthesis. Two vitamins i.e., cobalamin (Vitamin B12) and folic acid are essential for DNA biosynthesis. Hence deficiency of Folic acid and Vitamin B12 are the most common cause of Megaloblastic anaemia. Nowadays due to vegetarian lifestyle of the people Vitamin B12 is most common.
Large amount of cobalamin can be stored in our body and the diet of people living in Western India includes more amount of cobalamin which is enough to meet the requirements. Hence it can take 2–5 years to develop this deficiency. Synthesis of cobalamin is done by bacteria and can be found ion contaminated water and in soil. Dietary sources includes food originating from animals i.e., meat, eggs, milk etc.
Animal products are not consumed by the people who are vegetarian which develop deficiency of Vitamin B12. It is also found that the only source of Vitamin B12 for vegeterians is through the food that is contaminated by microorganisms. Hence, Vitamin B12 defficiency increases in adults and in children who are breastfeeded by vegan mothers. The megaloblastic affected population includes males, females, and also children.
| Materials and Methods|| |
The study is both prospective and retrospective. All patients who arrived at our Hospital for a period of 2 months, had a haemoglobin peripheral smear findings that are consistent with 10 g/dl The study included people with anaemia. Diet, drug use, and existing symptoms, previous blood transfusions, and other History that was pertinent was taken into account. Complete assessment of peripheral films, reticulocytes, and blood counts Assays for count, cobalamin, and folate were noted. Patients with long-term illnesses like cancer, renal disease, the study eliminated those who had tuberculosis, hepatic illness, etc.
| Results|| |
Five hundred patients in all who were admitted to the medical, paediatric, and gynaecology wards were assessed for the current study.
These patients were all eligible to participate. They were divided into three groups based on the MCV value, serum assay, and peripheral smear results: macrocytic, normocytic, and microcytic anaemia [Table 1]. The normal MCV value was regarded as macrocytic anaemia if there was a megaloblastic blood film or low serum markers.
Macrocytic anaemia was identified in a total of 100 individuals.
The distribution of sexes was 70 (male), 30 (female). Patients with cobalamin insufficiency made up 55% of the population, whereas those with folate deficiency made up 8% [Table 2]. All of the patients were vegetarians from lower socioeconomic classes and the middle class.
|Table 2: Megaloblastic anaemia distribution based on contributing factors|
Click here to view
Neurological problems (50%) and fatigue were the main symptoms (38%) Low grade fever, gastroenteritis, and anorexia Palpitation was diagnosed in a total of 100 cases.
| Results from the Lab|| |
The MCV varied from 70 to 128 fL.
Macro-ovalocytes, tear drop cells, basophilic stippling, polychromasia, hyper segmented neutrophils, or pancytopenia were found in the peripheral smear. Blood transfusions for anaemia were given to 30 individuals.
| Discussion|| |
Megaloblastic anaemia is a diverse set of illnesses with similar blood abnormalities and signs and symptoms. A unique bone marrow morphology affecting erythroid, myeloid, and platelet precursors is present along with the macrocytic anaemia, which is typically accompanied by leukopenia, thrombocytopenia, and other symptoms.,,,, A lack of folate or cobalamin (Vitamin B12) is the main cause of megaloblastic anaemia.
Megaloblast was initially used by Paul Ehrlich in 1880 to refer to the aberrant cells found in a patient's bone marrow who had pernicious anaemia. The most well-known kind of megaloblastic anaemia, pernicious anaemia, was first identified by Thomas Addison in 1855. The condition was referred to for a while as Addisoniananaemia. \s. The phrase “pernicious anaemia” was originally used by Anton Biermer in 1872.
Minot and murphy originally recognised Vitamin B12 as the extrinsic source of energy in the 1920s.,,,,
According to Markle and Okuda's review, the liver contains a substance called Megaloblastic anaemia that alleviates the signs and symptoms of pernicious anaemia. In 1948, the chemical was purified and given the name Vitamin B12.,,,,
In 1950, Hodgkin et al. discovered the crystalline structure of the Vitamin B12 molecule. The term “Vitamin B12” refers to a class of chemically categorised cobalamins that have physiological activity. A purine nucleotide (5,6-dimethylbenzimidazole) is connected to the central cobalt atom of the corrin's fundamental structure, which is a tetrapyrrole ring.
Megaloblastic anaemia is becoming more common, yet hard evidence may be difficult to find. It can be difficult to diagnose a Vitamin B12 deficiency. No one laboratory test serves as a gold standard, and there are no standardised diagnostic criteria.
For the diagnosis of this anaemia, a number of criteria have been utilised in the literature, including the presence of Megaloblastic alterations in the bone marrow and subnormal levels of micronutrients. In less than a decade at one location, macrocytic anaemia cases increased by almost a factor of four, from 2.5% in 1991 to 7.8% in 1999, according to Khurshid A et al. According to a recent study, 46.9% of nonanemic adult individuals had subnormal levels of Vitamin B12 or folate, with Vitamin B12 deficiency being five times more common than folate deficiency. According to a study from Mexico, folate deficiency was not seen, however B12 deficiency was found in 19%–41% of different population groupings. Another study on nursing moms in Guatemala found that 46% had B12 deficiency, compared to 9% who had folate deficiency. B12 deficiency was found in almost 50% of Megaloblastic anaemia patients from Pakistan and Zimbabwe, but folate deficiency was only identified in 8% and 17% of cases, respectively.
B12 deficiency was found in nearly 85% of instances of Megaloblastic anaemia, according to Nykjaer A et al. from Chandigarh. The same result was noted by Hesdorffer et al., Stouten K et al.,,, and a number of other researchers. In 1998, Gomber S. et al. conducted a study on the prevalence and cause of nutritional anaemia in young children in an urban slum. For the purpose of assessing the prevalence of nutritional anaemia, 300 children between the ages of 3 months and 3 years were randomly chosen and their data analysed over the course of a year. 41.4% of children with anaemia had pure iron deficiency anaemia (IDA). Children who were anaemic were found to have deficiencies of Vitamin B12 alone or in conjunction with iron in 14.4 and 22.2% of cases, respectively.,,,
Regardless of the origin, nutritional macrocytic anaemia currently seems to be more frequently caused by Vitamin B12 deficiency than by folate deficiency. Only iron and folic acid are provided under India's national nutritional programme for the prevention or control of anaemia. The rise in cases of Vitamin B12 insufficiency, which requires explanation, is highlighted by the numerous research conducted in the past and the current study.,,, The burden of Vitamin B12 deficiency should be recognised by the government, and it should be addressed in the anaemia control programme. Along with iron and folic acid, the Vitamin B12 tablet should be given out. The addition of Vitamin B12 to food is another choice that may be taken into account. By doing so, it may be possible to reduce the prevalence of Vitamin B12 deficiency and the level of subclinical Vitamin B12 deficiency. A few employees have proposed that Vitamin B12 fortification of foods may not be as successful due to malabsorptive problems.,,, However, in India, poor diet rather than absorption is the primary factor.
| Conclusion|| |
Megaloblastic anaemia is the second most common kind of anaemia after IDA. There is a dearth of information regarding the scope of the issue in Rajasthan's Hadoti region and the variables that can affect it. Megaloblastic anaemia brought on by a Vitamin B12 deficiency is linked to other systemic symptoms, and the morbidity is higher. Only iron and folic acid deficiency is addressed by our anaemia control programme. The national nutritional programme has to include Vitamin B12, particularly in the area where the majority of people eat vegetarianism. In their differential diagnosis of anaemia, the doctor must include Vitamin B12 insufficiency.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wickramasinghe SN. Diagnosis of megaloblastic anaemias. Blood Rev 2006;20:299-318.
Green R, Datta Mitra A. Megaloblastic anemias: Nutritional and other causes. Med Clin North Am 2017;101:297-317.
Sayar EH, Orhaner BB, Sayar E, NesrinTuran F, Küçük M. The frequency of vitamin B12, iron, and folic acid deficiency in the neonatal period and infancy, and the relationship with maternal levels. Turk Pediatri Ars 2020;55:139-48.
Borgna-Pignatti C, Azzalli M, Pedretti S. Thiamine-responsive megaloblastic anemia syndrome: Long term follow-up. J Pediatr 2009;155:295-7.
Stamm RA, Houghton LA. Nutrient intake values for folate during pregnancy and lactation vary widely around the world. Nutrients 2013;5:3920-47.
Toh BH. Diagnosis and classification of autoimmune gastritis. Autoimmun Rev 2014;13:459-62.
Wazir SM, Ghobrial I. Copper deficiency, a new triad: Anemia, leucopenia, and myeloneuropathy. J Community Hosp Intern Med Perspect 2017;7:265-8.
Khurshid A, Fatima S, Altaf C, Malik HS, Sajjad Z, Khadim MT. Thiamine responsive megaloblastic anaemia, diabetes mellitus and sensorineural hearing loss in a child. J Coll Physicians Surg Pak 2018;28:S169-71.
Porter FS, Rogers LE, Sidbury JB Jr. Thiamine-responsive megaloblastic anemia. J Pediatr 1969;74:494-504.
Birn H, Fyfe JC, Jacobsen C, Mounier F, Verroust PJ, Orskov H, et al
. Cubilin is an albumin binding protein important for renal tubular albumin reabsorption. J Clin Invest 2000;105:1353-61.
Nykjaer A, Fyfe JC, Kozyraki R, Leheste JR, Jacobsen C, Nielsen MS, et al
. Cubilin dysfunction causes abnormal metabolism of the steroid hormone 25(OH) vitamin D (3). Proc Natl Acad Sci U S A 2001;98:13895-900.
Hesdorffer CS, Longo DL. Drug-induced megaloblastic anemia. N Engl J Med 2016;374:696-7.
Stouten K, Riedl JA, Droogendijk J, Castel R, van Rosmalen J, van Houten RJ, et al
. Prevalence of potential underlying aetiology of macrocytic anaemia in Dutch general practice. BMC Fam Pract 2016;17:113.
Lindenbaum J, Rosenberg IH, Wilson PW, Stabler SP, Allen RH. Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr 1994;60:2-11.
Norman EJ, Morrison JA. Screening elderly populations for cobalamin (vitamin B12) deficiency using the urinary methylmalonic acid assay by gas chromatography mass spectrometry. Am J Med 1993;94:589-94.
Bizzaro N, Antico A. Diagnosis and classification of pernicious anemia. Autoimmun Rev 2014;13:565-8.
Gudgeon P, Cavalcanti R. Folate testing in hospital inpatients. Am J Med 2015;128:56-9.
Green R. Vitamin B (12) deficiency from the perspective of a practicing hematologist. Blood 2017;129:2603-11.
Tefferi A, Pruthi RK. The biochemical basis of cobalamin deficiency. Mayo Clin Proc 1994;69:181-6.
Wickramasinghe SN. Morphology, biology and biochemistry of cobalamin and folate-deficient bone marrow cells. Baillieres Clin Haematol 1995;8:441-59.
[Table 1], [Table 2]