Study to evaluate the role of serum LDH in the diagnosis of Megaloblastic anemia by treatment response at a tertiary care center in the northeastern part of India

Abstract

Megaloblastic anemia and Myelodysplastic syndrome are generally considered mutually exclusive diagnosis and at times becomes difficult to diagnose on the first encounter even after performing bone marrow examination. Aim of this study is to evaluate the role of LDH in the diagnosis of Megaloblastic anemia by treatment response at a tertiary care center in the northeastern part of India. Patients with age more than 12 years, Hemoglobin of patients less than 10 gm/dl, MCV ≥ 100 fl, Reticulocyte count <2.5 were included in the study. Based on serum LDH level patients were divided into two groups. Group A with serum LDH level ≥ 1200 U/L and Group B with serum LDH level of less than 1200 U/L. All these patients of serum LDH ≥1200 U/L were given a treatment trial of injectable Vitamin B12 containing 1000 μg of Vitamin B12 for 14 days. The response to treatment was monitored by an increment in reticulocyte count at day 5 and day 14. Bone marrow aspiration was done in all patients who had serum LDH less than 1200 mg/dl. Seventy-nine consecutive patients, who presented with anemia (Hb<10 g/dl) and macrocytosis (MCV > 100 fl) were included in the study. Median LDH values were higher in the patients who responded ( vitamin B12 deficient megaloblastic anemia ) as compared to non-responders. 93.5% of patients with megaloblastic anemia had Vitamin B12 deficiency, and in comparison, the folic acid deficiency was present among just 6.5 percent patients. Serum Vitamin B 12 and Folic acid level should not be used as a sole criterion for the diagnosis of Megaloblastic anemia and other parameters such as MCV, LDH, and characteristic blood picture, should all be taken into consideration before planning an appropriate treatment strategy.