Abstract
Background: Macrocytosis refers to a condition in which red blood cells are larger than normal, with or without anemia. Macrocytic anemia occur due to variety of illnesses and requires further clinical and laboratory assessment. Both folate and vitamin B12 have been known to cause macrocytic anemia since the deficiencies of these two vitamins are very common in Pakistan, it would be imperative to investigate their role in causing megaloblastic anemia.
Objective: To determine the frequency of vitamin B12 and folate deficiencies in cases of macrocytic anemia.
Material and Methods: This is a descriptive cross-sectional study conducted in the | department of medicine of Abbasi Shaheed hospital from January 2012 to June 2012. A total of 95 patients (65 males and 30 females) with an age of above 13 years, who admitted with macrocytic anemia (MCV>96) with hemoglobin < 12 mg/dl in females and < 13 mg/dl in males were enrolled and data pertaining to complete blood count, serum level of vitamin B12 and RBC folate were analyzed.
Result: A total of 95 patients (65 males and 30 females) with hemoglobin < 12 mg/dl in females and < 13 mg/dl in males were taken. Mostly were non vegetarian and majority of the patients belongs to age group of 34-54 years. It was found that 69 patients (48 males and 21 females) from total of 95 had vitamin B12 deficiency which is 72.6% and 43 patients (20 males and 23 females) from total of 95 had folate deficiency which is 45.26%.
Conclusion: Our study concludes that vitamin B12 is a major contributing factor of macrocytic anemia in our population. Dietary insufficiency, poor absorption and increase demand might be contributing to high prevalence of vitamin B12 deficiency in our population. Therefore our medical community should seriously consider the merit of early screening for vitamin B12 deficiency and take precautions against the clinical consequences of vitamin B12 deficiency.
References
Aslinia F, Mazza J, Yale S. megaloblastic anemia and other causes of macrocytosis. Clin Med Res 2006; 4(3): 236-41. http://dx.doi.org/10.3121/cmr.4.3.236
Wendy Brick, Russel Burgess-megaloblastic anemia and other causes of macrocytosis [Online
Rabhi S, Marroufi M, Khibri H, et al. Magnetic resonance imaging findings within the posterior and lateral columns of the spinal cord extended from the medulla oblongata to the thoracic spine in a woman with subacute combined degeneration without hematologic disorders. J Med Case Reports 2011; 5: 166. http://dx.doi.org/10.1186/1752-1947-5-166
Iqbal SP, Kakepoto GN, Iqbal SP. Vit B12 deficiency-A major cause of megaloblastic anemia. J Ayub Med Coll Abbottabad 2009; 21(3): 92-4.
Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood 2006; 107: 1747-50. http://dx.doi.org/10.1182/blood-2005-07-3046
Patel KV, Harris TB, Faulhaber M, et al. Racial variation in the relationship of anemia with mortality and mobility disability among older adults. Blood 2007; 109: 4663-70. http://dx.doi.org/10.1182/blood-2006-10-055384
Klee GG. Cobalamin and folate evaluation: measurement of methylmalonic acid and homocysteine vs vitamin B (12) and folate. Clin Chem 2000; 46(8 Pt 2): 1277-83.
Andres E, Perrin AE, Kraemer JP, et al. Anemia caused by vitamin B 12 deficiency in subjects aged over 75 years: new hypotheses. A study of 20 cases. Rev Med Interne 2000; 21: 946-54.
Hashim H, Tahir F. Frequency of vit B12 and folic acid deficiency among patients of megaloblastic anemia. Ann Pak Inst Med Sci 2006; 2(3): 192-4.
Yakub M, Iqbal MP, Mehboobali N, et al. High prevalence of folic acid, vitamin B6 and vitamin B12 deficiencies is a predictor of hyperhomocysteinemia in a Pakistani urban population. In: Abstract Book: 21st International Medical Sciences Student Congress. Istanbul University. Istanbul 2008; 75.
Khanduri U, Sharma A. Megaloblastic anemia: prevalence and causative factors. Natti Med J India 2007; 20(4): 172-5.
Naeem MA, Uttra GM. Etiology of incidence of megaloblastic anemia in district Gilgit. Pak J Pathol 2007; 18(1): 15-6.
Helicobacter pylori: A Cause of Vitamin B12 Deficiency World Applied Sciences Journal 2011; 12(9): 1378-81.