Megaloblastic anaemia in a hospital-based population

The study represents a retrospective analysis of 194 patients who were diagnosed to have vitamin deficiency anaemia at the Aga Khan University Hospital, Karachi, during the past 10 years. 62 (33%) had a confirmed diagnosis of megaloblastic anaemia on the basis of bone marrow examination and/or blood analysis. 76% of these cases (n = 47) were above the age of 20 years and this form of anaemia was nearly equally prevalent among both males and females. 77% (n = 48) of the patients had a severe type of anaemia. 40% (n = 25) also had leukopenia, while thrombocytopenia was present in 79% (n = 49) of the cases. 40% of the patients (n = 25) were pancytopenic. Macrocytosis was observed in 77% (n = 48) of patients. Regarding the underlying cause of the megaloblastic anaemia, 8% (n = 5) had folate deficiency and 67% (n = 40) had B12 deficiency, while 19% (n= 12) had both folate and B12 deficiency. There was one case of B6 deficiency, while the underlying cause in four cases could not be determined. More than 90% of our patients responded to supplementation with the appropriate vitamin(s). Most commonly associated symptoms include: weakness (62%), pallor (66%), fever (46%), recent onset diarrhoea (35%), vomiting (32%), abdominal pain (20%), breathlessness (20%), bleeding (17%), and neuropsychiatrie abnormalities (16%). Elevated activity of serum lactate dehydrogenase was apparent in 14 out of 15 cases. Megaloblastosis has been recognized to be an important cause of anaemia in Indo-Pakistan sub-continent. Our data indicate that megaloblastic anaemia in our patient population is mainly due to B12 deficiency. Contrary to general belief, folate deficiency was significantly less common in or megaloblastic anaemia patient population.