Yoganathan, C (2015) Etiological Profile of Macrocytic Anemia in Patients Admitted in PSG Hospitals. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.
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Abstract
INTRODUCTION: Macrocytosis is common in various clinical settings and it is found in approximately 1.7–3.6% of people admitted for care for any cause1,2,3. Macrocytosis would be seen even in the absence of anemia. Heterogeneous group of disorders acting via various known and unkwown processes can lead to macrocytic anemia. Macrocytic anemia is generally classified as megaloblastic or non-megaloblastic anemia. Disorders that affect the synthesis of DNA in the precursors of erythrocytes leads to megaloblastic anemia and other disorders through various processes causes non-megaloblastic anemia. Often we see macrocytosis preceding anemia4,5,6, which is usually not investigated, particularly when anemia is very mild. Vitamin B12 deficiency may perhaps produce only low grade macrocytic anemia which when persistant for a prolonged duration there is a rapid detoriation, which has been demonstrated in various case studies. Patient might present with similar symptoms irrespective of the cause for anemia. An increased value of MCV, among various other findings at regular laboratory investigations, might be the early feature of various disease states like low vitamin B12 or low folate levels, pre leukemia, drug induced or alcoholism7. Macrocytic anema would be wrongly diagnosed as iron deficiency anemia in many of the situations because of similar presentation of variety of anemias. When there is no response to iron supplementation after a latent period then only the diagnosis of megaloblastic anemia is offered. Suspicion at high level, properly eliciting the history and thorough examination of the patient will lead us in diagnosing macrocytic anemia. To search for and identification of distinct clinical features may help to diagnose megaloblastic anemia and also may help in the early identification of low levels of B12 or folic acid. AIMS AND OBJECTIVES 1. To identify the etiology of macrocytic anemia in patients presenting to tertiary care hospital in South India (PSG Hospitals). 2. To evaluate the causes for megaloblastic anemia. 3. To evaluate utilization of bone marrow examination and upper GI endoscopy in diagnosis of megaloblastic anemia. MATERIALS AND METHODS: This is a prospective and descriptive study which was done over a period of 12 months on 50 patients with age ≥15 years who were admitted with macrocytic anemia in PSG hospitals, Coimbatore. Macrocytic anemia was diagnosed in patients with 1. A mean red blood corpuscular volume >95 fl and 2. Anemia with a hemoglobin of; a. < 13 gm/dl in male patient, b. < 12 gm/dl in female patient. Inclusion Criteria: Patients above the age of 15 years with macrocytic anemia. Exclusion Criteria: Patients with decompensated liver disease, chronic kidney disease, Hemolytic anemia, Hemorrhagic disease. Post splenectomy and pregnant patients. RESULTS: In our study population of fifty patients presenting with macrocytic anaemia 34 were male comprising about 68% and 16 were female comprising about 32%. The mean age of male and female were 53.15 ± 15.89 and 54.37 ± 16.58 respectively. Majority of the population belong to the age group above 40 years, both in males and females. CONCLUSIONS: 1. Even though many diseases might lead to macrocytic anemia our study shows megaloblastic macrocytosis as the most common cause. 2. This demonstrates that megaloblastosis still remains the most significant reason for macrocytic anemia in our population which causes substantial morbidity. Low serum B12 vitamin was leading cause of megaloblastic anemia. 3. Considering megaloblastic anaemia as one of the differentials in pancytopenia is important. 4. Bleeding was not a presenting complaint in patients with thrombocytopenia due to B12 deficiency. 5. We observed in our study that being a non vegetarian does not protect against Vitamin B12 deficiency. 6. Although our study had very small number of cases with drug exposure, clinical history of drug intake is essential in evaluating for megaloblastic anemia. 7. Macro-ovalocytes and hyper-segmented neutrophils occurring in peripheral blood smear would significantly favour towards diagnosing megaloblastic anemia. 8. The severity of anemia did not have any correlation with the levels of serum B12 or the degree of macrocytosis. 9. Upper GI endoscopy with deep duodenal biopsy should be done in all patients with megaloblastic anaemia. 10. The prevalence of tropical sprue is also quite great. The high prevalence of tropical sprue as established in this study has not been revealed in any other study before. This emphasises the significance of evaluating tropical sprue in a suitable settings to the clinician.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Macrocytic Anemia ; Etiological Profile ; Patients ; PSG Hospitals. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Punitha K |
| Date Deposited: | 18 May 2018 18:58 |
| Last Modified: | 18 May 2018 18:58 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7972 |
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