vedantaa.instituteCreated Date: 5/31/2019 10:34:21 AM
Transcript of vedantaa.instituteCreated Date: 5/31/2019 10:34:21 AM
Volume :4 | lssue: 12 | Dec 2014 I ISSN -2249-555X
Clinical & Haematological Profile of MegaloblasticAnemia- A RetrosPective StudY
Megaloblastic anemia is charac'terised by decreased haemoglobin level with elevated me4n corpqisc.ular
volltme (MCW1 ,2. Patients may present with general symptoms of anemia, sometimes neurological in-
vlolvement. De{iciency o{ v.itamin B 12 or folic acid which leads to impaired DNA synthesis gives rise to.macro^?fi:RBCs, ineffective erythropoiesrs & intramedullary haemolysisl ,2. This leads to rise in unconiugated billkubin, LDH &
also variable degree of cytopenias.
Aims & Objectives: To study.various symptoms, clinical {indings & haematological parameters of megaloblastic anemia-
Materials & methods: This was a retrospecl.ive observational type of study. The study was conduaed on patients admit-
ted in medicine department of SKN Medical College & Genergl HosPital, Pune .during_period.Jan 2a14 b Ocr2A14.
ih. .rr" records of 220 patients of anemia were reviewe.d & 3^0 ca^sgs o-{-megaloblastic anemia were selected for the
stLjdv- patients with diagnosis of megaloblastic anemia, Hb <10gm% & MCV 100f1 were se/ected for the study. Their
,..Jra, were reviewed. Data *ut cil[u.t d in terms of clinical findings & laboratory Parameters. .All cell counts were
Jii. ""
aulomated cou/ter' machine & peripherals smear reported by pathologist. Data was analysed using standard
statistical tests- Results are presented in form of tables & graphs-
Conclusion: Megaloblastic ariemia has wide clinical .& haematological.,spe.ctrum. lh.orough clinical assessment, good
ii.iiiiuii"n of "peripherat smear is vital for diaglosrs. Findings of pallor, icterus & leukopenia; thrombocytopenia are
commonly seen in o,ur rrrOt : '
cn. According to WHO anemia is defined as Hb < 13
"/ in males, Hb < 12 gm1" in females & Hb < 11 gm"/"
pregnant females3. Based upon RBC morphology.ane-
i isilassified as Normocytic, Microcytic & Macrocytic (or
Anemia is a common problem in our popu-
ic). Megaloblastlc anemia is characterised by
anisocytosis & poikilocytosis lvlCV in mega-
: anemia is ) 100 fl1-3. Causes of megaloblastic
are Vit. 812 or folic acid deficiency or abnormality
to therapy with vitamins & supportive care is generally- good2's.
Aims & Objectives: 1) To study various symptoms & clini-cal findings in patients of megaloblastic anemia- 2) To
study various haematological parameters in patients ofmegaloblastic anemia.
Materials & inethods: This was a retrosPective observa-
tional type of study. The study raras conducted on Patientsadmitted in medicine department of SKN Medical College& General Hospital, Pune during period Jan 2014 to Oct2014.The case records o{ 220 patients o{ anemia were re-
viewed & 30 cases o{ megaloblastic anemia were.selected
for the study. Since anemia is extremely common in ourprcpulation, we included patients with Hb < 10 9m7o.
lnclusion criteria: Patients with diagnosis of megaloblastic
anemia, HQ <1Ogm% & MCV ) toO fl.
Cases fulfilling above criteria were selected for the study.Their recordi were reviewed. Data was collected in termsof clinical findings & laboratory Parameters' All cell countswere done on automated coulter machine & peripheralssmedr reported by pathologist. Data was analysed usingstandard statistical tests. Results are Presented in {orm oftables & graph.
Results: The study consists of 30 patients of megalobla5ticanemia, Males & Females being equal in no. Male to fe-male ratio 1:1- The age varied from lowest 16 yrs to high-est 78 yrs. Mean age was 48.33* SD of 18.90. The agewise distribution is shown in graph l.
of their metabolism. lmportant clinical conditions leading
to megaloblastic anemia are recurrent diarrhoea, malab-
sorption syndromes, worms, Gl surgery nutritional - strict
vegans, chronic liver disease, drugs like methotrexate,
chemotherapeutic agents, anticonvulsants, proton pump
inhibitors, prolong antibiotic use, metformin, alcohol etc'
Vit. 812 & {olic acid are important for DNA & RNA syn-
thesisa. Their de{iciency causes ineffective erythroPoiesis &
intramedullary haemolysis- This ultimately results in mega-
loblastic changes. Other {eatures are variable degree ofleukopenia, thiombocytopenia, 3nd hypersegmented neu-
trophils on peripheral smear. Unconjugated billirubin & se-
rum LDH are ralsed. Bone marrow is usually hypercellular
with accumulation of primitive cellss' Patients usually pre-
sent with general symPtoms like shortness of breath' easy
fatigue, dJcreased appetite, weakness, oedema over feet'
On examination they have pallol sometimes glossitis' ic-
terus, hepato-splenomegaly or feature o{ congestive heart
failure. Small subset o{ patients have neurological involve-
ment due to demyelination. The neurological manifesta-
tions include peripheral neuropathy, ataxia, gait abnormal-ity, dementia & mental changes. The Patients should beinvestigated for sr- 812 & folic acid acid level. They usuallyrequire high doses of deficient vitamin or both. Response
MBBS, MD (MEDICINE), HOD OFMEDICINE, SMT. KASHIBAI NAVALE
MEDICAL COLLEGE & GENERALHOSPITAL, NARHE, PUNE.41 1041
MBBS, MD (MEDICINE), DEPT. OFMEDICINE, SMT. KASHIBAI NAVALE
MEDICAL COLLEGE & GENERALHOSPITAL, NARHE, PUNE-41'I 041
BBS, MD (MEDICINE), DEPT. OF
EDICINE, SMT. KASHIBAI NAVALE
MEDICAL COLLEGE & GENERALHOSPITAL, NARHE, PUNE.41 1041
INDIAN JOURNAL OF APPLIED RESE/qRCH E 67
EYWORDS , :
)R,-, i r.r
I
Vofume : 4 | tssue : 1Z I DecZ014l ISSN _ 2249_S55XGraph l: Age wise distribution of study population Graph ll: Frequency of pancytopenia & bicytopenias inthe study:
AGE20
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Frequency of different clinrcal features in the study popula_tion rs shown in the table below.
Table l: Frequency of different clinical features:
Symptom No. Of cases Percentage (%)
3eneral Symptoms 73.33
Neurologicalrnvolvement o2 6.61
Pallor 30 100
Jaundice 10 aa a)
Hepatomegaly 07 23 33
Splenomegaly x7 23.33
tci80.70
60
lsodo
_10
20
lro0
Lab. parameter No. Of cases Percentage (%)
Pa ncytopen ia 11 36.67
3icytopenia (anemia. leu-<openia)
1)CJ.JJ
Bicytopenia (anemia,throm bocytopen ia) 19 63.33
Feripheral smear examination showed low haemoglobinwith macrocytic RBCs along with anisocytosis a poi[ito.y-tosis., 13 (43.33%) patients had hypeisegmented poli-lTIh: ^""
.,T:.r; Leu.kopenia was seen ;, i: (+: riZ) purients_ Lowest leukocyte count in our study popularion was1800/cmm- Thrombocytopenia was seen'in iS (6:::Ztpatients. However none had reported signi{rcant
"b,norrn"jbleeding.contrasting to other studies. -
ll tli.ii\"l pa-tients had pancytopenia.Table lll: Various lab parameters in the study popula_tion:
t. ifti!t.r'. ! li
t8
16.- .-
1{,12
10
8
r AndIia & lsrkopenjir
I Alrenia Ithronbo(ytopffti.r
.: Pntr(ytopenia
Lab. parameter Mean
Hb 6.41 gm%
TLC 4987/cmmPlatelet count 1,53000/cmmMCV 115 ftST, LDH 2927.75
freque
METH15th (scriPti
RESUI\/ear5.
ths
CONt
NTROT
{coPD), worldrv
is a Precant e)
nary er
sometiafiectand mhYPertle{t veraPhYcardia& funries h:nale'1are a:effortsen tir
JlATIcondpita I ,
stu d.maleof st
lnc[AII r
the
Excl1. F
2.(3
General symptoms like easy fatigue, shortness of breath,oedema, weakness were present in 22 (13.33%) patients,.Pallor was present in all patients as in most of ti-re stud_ies. Clinical jaundice was seen in i,/3 study population.These patients had predominantly high unconjugated bil-lirubin indicating intramedullary haemoiysis. Hepatomegaly& splenomegaly was present in 07 (23.33o/o) patjents each.Neurological involvement was not common in our study,{ound in only 02 (6,67%) patients. These clinical find;njiare comparable other studies like Hirachand Sr, VineethaUnnikrishnan6 & Muhammad Bilal KhattakT
Distribution of various laboratory parameters is shourn infollowing graph. & tables.
Table ll: Frequenry of panqrtopenia & bicytopenias inthe study:
]Y.::l 1,"".:y]"?1" ,: the study popularion was surrerow (o.4 t qmyo). Ihis is probably because this is a tertiarycare hospital & only inpatients were included in the study.M31n MCV of all patients was l l5 {1. in the study conduct_ed by Hirachand 53 & oihers, the frequency oilytop"niu.was lower than our study where as Vineetha Unnikrishnanu& others reported more {requent cytopenias. MuhammadBilal Khattak? reported much higher occurrence of-prn.y_topenia, although mean values of Hb, leukocyte &'plate_let count were similar to our study. lnteresting finding inthe study was that mean sr. LDH was high _ a6out 5 to 6times the upper limit of normal. Out oitotal 30 patientssr. LDH was measured fbr 17 patients & it was elevated in15 patients (88%). Similar finding has been shbwn in otherstudiess.
Conclusion: Megaloblastic anemia has wide clinical & hae-matological spectrum. Thorough clinical assessment, goodexamination of peripheral smear is vital for diagnosis. Find-ings of pallor, icterus & leukopenia, thrombocftopenia arecommonly seen in our study.
l"*:,r5.rflfl:i5,3r1.#"13,Xii?;J"",[y:,::y*rj=l-1!ly wtlfls, rRrs DUGARTE and ADEfINA oJEDA "MesarobranicE7AnemjaofPregnancy:chaGderistic5ote".r,.g,l"Iu',;.;;;;",,;;T;"L,j".il},|xi#Xi"T'.i:f.1Ti:xl#i:3i;"y;#::r*;ltJii"l.!t.l;1ru:!,*l.f::?*"]l-y"",.d*Fll. Ili-!?t:iri,.",.gut",,"ir ."g.i"ui"=.,#?1._o".rHErANcEr.vor 34eiJanuatu1r 1ee7-,?,jxi*[..ai sirgi n, cr*,s ;r;,Ji;;;;;:"4;#;;#l*'ol!,;,'''u'us""nt ot I meqaloblastic anaemia". rHE tANcEr, Vol 34e'; January. ir ,, 1se7, 13 | 3.Marcolms. Druskin, M.D., Matuen H. warren, M,D.andLucasr"",",,,lil'i"t,T:-?1*1:,1]::l:1':.",'q,.maiof instituteof meliii*,rp{iora,ai,r, siazii.|:1[']T.:;3fr'"i,1;,yJ;;il::r# ];ffi?;li?;""T,![r',i;i",,,,t]ihl,irfflll,"-ffi':+i:',q,"ffi#il*:':lllr"ii'J','f ,1,i.'#rj;ForicAcidAdministered bvMouth Dairy", N e,sr.r;'r"JirZ)-,%;.;-s1,l6ils1a{'"ffi#:il'#;::i:::,T"?"rli.^?";[:3ffiffi;jff,;f,tf;i:1X?.T#llil:Hi:lt#*5#:l fllTi; 3l',filj,j. 8".'j; ;:,:'*::",1,f?P*[ 11[;i,"I:j1hr;:z,r:i:jiJiiosic pro,i re,or macroqric anemias uriih speia, rererence::.EE;il,i.TX^il"&i*it?ili"?il,"lli 3ff€*e#;,i1ni#;l:;i*,*mttfl*i:j.fr,* M":j:anti.:lr".ff;lg,j:#ir-i{tili,1.""j:?P5ll9lY!Yli ,I1/:b r',r.a.c^ar.muott,u"7fiiz.B"jie"i";-:jii;.;:;iJHc. Gupta y Sinsh M. sinsh s., "serum ractate der,ya,{oa;;;;;r;s,iJ;;I]s;i.fi1;*ll,li.;iii'i;J::"r;:lrffi,:::f,j.,r[lt:}ii,,j,ij#i
68 E INDIAN JOURNAL OF APPLIED RESEARCH