Cases Of Megaloblastic Anemia Research Articles

Vitamin B12 deficiency-induced megaloblastic anemia in a pediatric patient with autism spectrum disorder with a chronically unbalanced diet.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by a lack of behavioral flexibility and stereotyped language. Food selectivity is common among children with ASD because of their persnickety nature. A prolonged unbalanced diet results in an increased risk of several diseases, such as iron deficiency anemia, scurvy, rickets, dry eye, and Wernicke encephalopathy. However, no cases of megaloblastic anemia have been reported to date. We report the case of an 11-year-old boy with ASD who developed megaloblastic anemia due to vitamin B12 deficiency. He had a prolonged history of selective eating for more than 10years. His nutritional status on admission was poor, and he had low weight and short stature. His food selectivity was so strong that intervention to expand diet variety was unsuccessful. A developmental-behavioral pediatrician found that the patient had visual dominance and could take some medications when suffering from a minor illness. Nutritional supplements were selected after consultation with a nutritionist. Although compulsory treatment was necessary during the acute phase, the therapy was continued at home. With multidisciplinary intervention tailored to the patient and his parents' characteristics, his nutritional status improved in a few months.

A case of megaloblastic anemia with thrombocytopenia occurring in late pregnancy and diagnosed in the postpartum period

A case of megaloblastic anemia with thrombocytopenia occurring in late pregnancy and diagnosed in the postpartum period

Tongue disorders due to megaloblastic anaemia and its management: A case report.

The presence of megaloblasts and macrocytes in the bone marrow characterizes megaloblastic anaemia. Megaloblastic anaemia is the result of folate and vitamin B12 deficiency in more than 95% of cases. We hereby report a case of megaloblastic anaemia in a 23-year old female having glossitis and a burning sensation on the tongue. The blood picture showed megaloblastic anaemia and haematological tests confirmed the diagnosis. The patient positively responded to vitamin B12 and folic acid supplementation. The presence of oral signs and symptoms offer the dentist an opportunity to participate in the diagnosis of this condition. Early diagnosis is important to prevent deficiency. This paper explains the oral changes induced by dietary deficiency of cobalamin or folate in a patient with megaloblastic anaemia.
 Update Dent. Coll. j: 2021; 11 (1): 26-28

Megaloblastic anemia in a 9-weeks old infant

Megaloblastic anaemia due to vitamin B12 and folic acid deficiency is uncommon in infancy and rarely reported in infants below 3 months of age. We hereby report a case of megaloblastic anaemia in a 9-weeks old infant having fever from 7th week of life. Blood picture showed pancytopenia and diagnosis was confirmed on bone marrow biopsy and serum level of vitamins. Patient positively responded to vitamin B12 and folic acid supplementation. Infants with pancytopenia even younger than 2 months, should also be investigated for vitamin B12 and folate deficiency. Mother of the baby was not antenatally investigated for anaemia. Prompt antenatal diagnosis and treatment of mothers can reduce the incidence in the infants.

Bone marrow aspiration and anemia; Diagnostic importance of bone marrow aspiration and biopsy in evaluating patients presenting with anemia of unknown etiology.

Objectives: To determine the diagnostic importance of bone marrow aspiration and biopsy in work up of cases presenting with anemias of unknown etiology. Study Design: Cross sectional descriptive study. Setting: Pathology Department, Khyber Teaching Hospital, Peshawar. Period: July 2015 to July 2017 (two year). Material & Methods: All patients presenting with anemia (Hemoglobin less than 12gm/dL for females and 13 gm/d L for  males), whose cause cannot be established on clinical history, examination and blood counts, and were thus referred for bone marrow examination for further workup were included in the study. Patients having malignancies, chemotherapy or radiotherapy associated marrow suppression, and those with diluted marrow unfit for comments were excluded from the study. Bone marrow aspiration and biopsy was done, slides were examined, and diagnoses was made and recorded. The results were drawn accordingly. Results: A total of 199 patients were referred for bone marrow aspiration, presenting with unexplained anemia, during the study period. About 12 patients had blast cells on peripheral blood film, giving diagnosis of leukemia. So they were excluded from the study. Remaining 187 cases were included in the study. The age of the study sample ranged 3 years to 63 years (mean age 42 years ±8.1 SD). There were 96 (51%) males and 91 (49%) females. Male to female ratio was 1.05:1. Out of 187 cases presenting with unexplained anemias, about 44(23.5%) cases were of iron deficiency anemia, 39(20.7%) cases were of anemia of chronic disorder, 16 (8.7%) cases as hemolytic anemia, about 19 (10.3%) cases as aplastic anemia, and 52 (27.8%) cases of megaloblastic anemia on bone marrow examination. Conclusion:  Bone marrow aspiration and biopsy successfully gives the final diagnosis in cases of anemia where cause cannot be found by routine lab investigations. It helps physician decide further management plan of the patients. So, it should be done in all cases with unexplained anemia.

A Case of Megaloblastic Anemia With Suspected Gilbert Syndrome

A Case of Megaloblastic Anemia With Suspected Gilbert Syndrome

A female with classical paroxysmal nocturnal hemoglobinuria misdiagnosed as megaloblastic anemia

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disorder of the hematopoietic stem cells, which manifests as bone marrow failure, hemolytic anemia, and thrombosis. PNH affects both sexes equally and may present at any age, although it is most often diagnosed in young adulthood. Here, we report a case of a middle-aged woman, presented with one and a half year history of anemia, significant fatigue, backache, and persistent high erythrocyte sedimentation rate. The patient has no organomegaly and did not give a history of thrombotic events previously. She was considered as a case of megaloblastic anemia at another center and treated accordingly. Her full blood count showed mild macrocytic anemia with slight polychromasia. The hemolytic anemia workup revealed slightly raised serum bilirubin (unconjugated) and undetectable haptoglobin with hemosiderin in urine. Ham's test was positive, and the diagnosis of PNH was confirmed by flow cytometry. The patient was treated with short-course steroids and folic acid, and her general condition has become stable.

A study of clinico-hematological profile of pancytopenic patients in Central India

Background: To segregate the causes of pancytopenia which are easily treatable, from those requiring sophisticated investigations & vigorous treatment, based on clinico-hematological profile of the patients and affordable diagnostic mathods. Materials and Methods: 180 Pancytopenic patients were evaluated clinically along with hematological parameters, peripheral smears and bone marrow aspiration in the Department of Pathology, GMC, Bhopal for 3 years. Result: Age range was 5 months-70 years (mean- 26.6 years), with Male preponderance (M: F: 1.76:1). Commonest symptoms were weakness (97.8%), breathlessness (75%) and signs were pallor (98.3%) and splenomegaly (25.5%). Patients who presented with per rectal bleeding, in 46.2% diagnosis was dimorphic anemia thus per rectal bleeding was cause of associated iron deficiency. Commonest peripheral smear finding was microcytic hypochromic picture (27.22 %) & bone marrow was hypercellular (70.00%). Bone marrow aspiration revealed commonest cause was megaloblastic anemia (25%) followed by dimorphic anemia (17.2%) and infections (17.2%). In our study MCV was <100 fl in 12/45 (26.66%) cases of megaloblastic anemia so even if a patient presents with MCV < 100 fl megaloblastic anemia should not be ruled out only on this basis. Sensitivity of peripheral smear for dimorphic anemia was very low 35.48% and specificity was 82.55%, so bone marrow examination should be investigation of choice for inconclusive peripheral smears. Conclusion: Common causes of pancytopenia were easily treatable and reversible & can be detected by early and affordable diagnostic methods therefore should be considered at higher order in differential diagnosis of pancytopenia.

Bone marrow aspiration study of megakaryocytic alterations in non myelodysplastic syndrome related thrombocytopenia

Background: Thrombocytopenia is a common hematological condition associated with variable etiological factors. Dysplastic changes of megakaryocytes in thrombocytopenia are commonly seen in myelodysplastic syndrome (MDS). However, several studies have described it’s occurrence in non-myelodysplastic hematological conditions. The present study was undertaken to note the various morphological alterations in megakaryocytes (including both dysplastic and non dysplastic changes) in non MDS related thrombocytopenia. Materials and Methods: A prospective study of 78 cases with thrombocytopenia were included in the present study. Cases of MDS were excluded from the study. Informed consent was taken from all the patients with thrombocytopenia and Bone marrow aspiration was done in all cases. Bone marrow aspiration smears were air dried and stained with Leishman stain. Bone marrow aspiration smears were examined for number and various morphological alterations. Special investigations were done in required cases for confirmation of diagnosis. Results: Dysplastic megakaryocytes were observed in 78.6% cases of immune thrombocytopenic purpura and 41.2% cases of megaloblastic anemia. Most common dysplastic feature observed was micromegakaryocyte (32.0%) followed by multiple separate nuclei (21.7%) and hypogranular form was the least observed dysplastic feature (8.9%). Conclusions: Dysplasia in megakaryocytes is a common finding in various non-myelodysplastic syndrome related thrombocytopenia. The mere presence of dysplastic megakaryocyte should not prompt an interpretation of myelodysplastic syndrome and should always be correlated with patient’s clinical and other hematological parameters.

A Case of Megaloblastic Anemia with Thrombocytopenia

Megaloblastic anemias are a group of hematologic disorders in which abnormal DNA synthesis causes blood and bone marrow disorders. This type of anemias occurs as a result of folic acid deficiency or impaired vitamin B12 absorption. The prevalence of this type of anemia is highly variable worldwide and megaloblastic anemia caused by lack of vitamin B12 (cyanocobalamin) is rare during pregnancy [1]. In this case report, we report follow-ups conducted for a pregnant 33-year-old woman, G2, P1, with a history of previous natural childbirth who attended Kamali Hospital due to labor pain associated with severe thrombocytopenia. Although this woman was injected 10 units of PLT and also vitamin B12 (cyanocobalamin), folic acid and corticosteroids in the course of treatment, her platelet level has not yet returned to normal levels after 6 months and she is still being treated.

Interpretation of Bone Marrow Trephine Biopsies in Hematological Disorders with Special Emphasis on Morphological Patterns in Lymphomas

Context: Hematological disorders are seen in all age groups. Bone marrow trephine biopsy plays a major role in the diagnosis of underlying causes, in addition to staging and follow-up of hematological malignancies. Aims: To study the trephine biopsies received in the department of clinical pathology with respect to age and sex incidence, to correlate with bone marrow aspirations, with special emphasis to its importance in cases where bone marrow aspiration yields a dry tap. Settings and Design: 105 cases of bone marrow trephine biopsies performed in our institution over a period of one and a half years are included in the study. Methods and Materials: A prospective study of 105 cases of bone marrow trephine biopsies was conducted. The biopsies were fixed in 10% buffered formalin solution and decalcified using 5% concentrated nitric acid for 4-6 hours, followed by routine processing. Serial sections were stained with Hematoxylin and Eosin (H and E), reticulin stains and Immunohistochemical markers in some. Results: The majority of bone marrow biopsies showed reactive marrows (42 cases) followed by normal marrows (12 cases) and hypoplastic marrows (5 cases). Bone marrow biopsy showed involvement by leukemias in 11 cases(10.5%), lymphomas in 8 cases (7.6%),Myeloma in 6 cases(5.7%)and secondary deposits in 2 cases (1.9%). There were 5 cases of Megaloblastic anemia(4.8%), four cases of myelofibrosis (3.8%), two cases of idiopathic thrombocytopenic purpura (ITP)(1.9%) and one case each of aplastic anemia and autoimmune hemolytic anemia(0.9%). Out of 8 cases of  Non Hodgkin’s lymphomas - 3(37.5%)  showed nodular, 2 diffuse(25%), 1(12.5%) interstitial pattern, 1 interstitial diffuse(12.5%)  and 1 para trabecular pattern(12.5%) of marrow infiltration on trephine biopsy section. Nodular, interstitial and para trabecular patterns had good prognosis. Interstitial diffuse had intermediate prognosis and diffuse pattern had bad prognosis. There were 28 cases of dry tap in bon

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BACKGROUND AND OBJECTIVES: To study complete clinical profile of ocular manifestations in haematological disorders METHODS: This was a prospective non-interventional study done on 60 cases admitted and diagnosed with various haematological disorders in Medicine, Paediatrics, Obstetrics and Gynaecology wards. Whenever general condition permitted, patients were examined in more details in the Ophthalmology O.P.D. For the record of visual acuity, a standard Snellen's chart was used. Dilated fundus examination was done in every case. Patients with diabetes, hypertension and dense cataracts were excluded. RESULTS: Out of total 60 cases, 39 cases of anaemia, 13 cases of leukaemia, 4 cases of haemorrhagic disorders and 4 cases of haemoglobinopathies were studied. Conjunctival pallor was observed in all cases (100%) of anaemia and fundal pallor in 38.46 % cases. Retinal haemorrhages were present in 57.14 % cases of megaloblastic anaemia, 50% cases of combined nutritional deficiency anaemia and 60% cases of aplastic anaemia, but absent in iron deficiency anaemia cases. Overall incidence of ocular manifestations in leukaemia was 69.23%. It was higher (87.5 %) in acute leukaemia as compared to chronic leukaemia (40%). Two cases of purpura with associated anaemia showed retinal flame shaped haemorrhages. Thalassemia major cases showed changes like conjunctival pallor and fundal pallor. CONCLUSION: It is essential to examine all patients’ with haematological disorders for ocular manifestations as it helps in diagnosis and prognosis. Early recognition of the ocular manifestations is of great importance as early institution of treatment may prevent or alleviate both ocular and systemic complications.

Severe megaloblastic anaemia presenting as pancytopenia with red cell hypoplasia and elevated serum cobalamin and cobalamin binding proteins

In severe megaloblastic anaemia due to folate or cobalamin deficiency the bone marrow is usually hypercellular with megaloblastic change in erythropoiesis and giant metamyelocytes in the myeloid series. We report an unusual case of megaloblastic anaemia with marked erythroid hypoplasia and myeloid hyperplasia; the serum cobalamin and unsaturated cobalamin binding capacity were both grossly elevated.

A case of megaloblastic anemia caused by antiepileptic drugs during total parenteral nutrition

A case of megaloblastic anemia caused by antiepileptic drugs during total parenteral nutrition

A Case of Megaloblastic Anemia that Developed after Intestinal Tube Feeding for Six Years

A Case of Megaloblastic Anemia that Developed after Intestinal Tube Feeding for Six Years

Severe folate deficiency in pregnancy with normal red cell folate level

We report here a case of megaloblastic anaemia in late pregnancy, which leads us to question whether folate supplements should be recommended in the UK routinely throughout pregnancy and not just in the preconception period and first trimester.

Soluble transferrin receptor and iron status in elderly patients.

The measurement of soluble transferrin receptor (sTfR) has been proposed as a novel approach to the diagnosis of iron deficiency, especially in anaemia of chronic diseases (ACD). Our aim was to study the utility of sTfR under 'everyday conditions' as seen in a geriatric hospital in the following groups of patients: First, in a pilot group of 99 multimorbid geriatric patients (85 women, 14 men; 82.00 +/- 6.32 years) admitted for rehabilitation after recent surgical treatment of a bone fracture; second, in 677 geriatric patients (506 women, 171 men; 79.17 +/- 11.47 years) with different diagnoses admitted to a department of internal medicine; third, in some remarkable clinical cases in order to illustrate the diagnostic limits of sTfR. In general, both genders showed a remarkable age-dependent decrease in erythropoiesis. In patients with haemoglobin levels below 12.0 mg/dL, this parameter correlated significantly with sTfR. However, this was seen only in women, not in men. Moreover, an age-dependent increase in sTfR was seen in women, while in men it remained almost constant. Based on these findings, we conclude that there is a different, gender-specific aetiology of iron deficiency in the elderly. About 30% of patients of both genders simultaneously had low haemoglobin levels and low sTfR. This was interpreted as 'adaptation' or 'tolerance' to the iron deficiency. This was illustrated by a clinical case of megaloblastic anaemia: Initially low sTfR rose only during the vitamin B12 substitution and normalized after recovery. We conclude that sTfR provides an insight into the 'dynamics' of iron metabolism: A rise in sTfR indicates an 'acute readiness to refill iron stores', while a low (non-stimulated) sTfR level corresponds to the quite frequent adaptation to iron deficiency and/or inhibition of resorption. Finally, extremely high sTfR levels were observed in some cases of malignancy such as in acute leukaemia and in hypernephroma. Thus, increased sTfR levels can be caused by paraneoplastic effects.

A Case of Megaloblastic Anemia Caused by Folic Acid Deficiency Due to Poor Diet

A Case of Megaloblastic Anemia Caused by Folic Acid Deficiency Due to Poor Diet

Folic acid deficiency enhances oral contraceptive-induced platelet hyperactivity.

In previous studies conducted in female rats and in women, oral contraceptives (OC) were found to induce a platelet hyperactivity that was related to an oxidative stress. Because cases of megaloblastic anemia have been reported to occur in women taking OC, these treatments are suspected of depleting folate stores. In the study presented herein, which was conducted in rats, we sought to determine the influence of dietary folic acid deficiency (FD) on the thrombogenicity of OC. Animals were fed for 6 weeks with either a folic acid-deficient diet (250 micrograms/kg folic acid) or a control diet (750 micrograms/kg). One-half of the animals in each group were treated with OC (ethinyl estradiol plus lynestrenol). FD and OC individually potentiated platelet aggregation in response to thrombin and ADP and the release and metabolism of arachidonic acid, in particular, the biosynthesis of thromboxane. These platelet activities were further enhanced in animals given both the folic acid-deficient diet and the OC treatment. In addition, FD enhanced the pro-oxidant state in OC-treated rats characterized by (1) a fall in platelet and plasma n-3 fatty acids, (2) an increase in plasma lipid peroxidation products such as conjugated dienes, lipid peroxides, and thiobarbituric reactive substances, (3) a rise in ex vivo erythrocyte susceptibility to free radicals. Moreover, we found that OC treatment led to a reduction of plasma and erythrocyte folate concentrations associated with a moderate hyperhomocysteinemia. Under our experimental conditions, we did not find significant synergistic effects between OC and FD. We propose that, although the untoward effects associated with the OC treatment may not primarily be dependent on FD, the folic acid deficiency magnified OC-induced oxidative stress, which resulted in platelet hyperactivity by elevating the pro-oxidant homocysteine plasma concentration. Despite the limitations of this animal model, the data of the present study suggest that in addition to cigarette smoking, inadequate folic acid intake might predispose those taking OC to vascular thrombosis.

A Case of Megaloblastic Anemia in Childhood due to Congenital Deficiency of Intrinsic Factor, and Review of 33 Cases Reported in Japan

A Case of Megaloblastic Anemia in Childhood due to Congenital Deficiency of Intrinsic Factor, and Review of 33 Cases Reported in Japan