Prevalence and Clinical Profile of Megaloblastic Anemia in Children

Dr. Sujata Sharma, Dr. Suroor Makharia, Dr. Aashna Gupta, Prachi Pandhare

Abstract: Introduction: Megaloblastic anemia is an underestimated disease of nutritional origin in children. Contrary to earlier times, this entity has become much more frequent today. Veganism is one of the common reasons for an increase in the prevalence of nutritional megaloblastic anemia. Deficient mothers often have children with vitamin B12 deficiency with megaloblastic anemia and various neurologic manifestations. It presents with varied clinical features in childhood, sometimes mimicking a hematological malignancy like leukemia. Diagnosing this disease assumes great clinical importance since it responds exceedingly well to treatment. Objective of the study: 1) To study the prevalence and clinical profile of megaloblastic anemia in children referred for anemia, 2) To determine the high risk factors for occurrence of megaloblastic anemia in children and 3) To find out the effectiveness of treatment in these children. Material and Methods: This study was a retrospective analysis of children referred for anemia to the Pediatric Hematology - Oncology Division of a tertiary care centre over the last 3 years from January 2020 to July 2023. Clinical data was charted in a proforma and all patients underwent a complete hemogram, corrected reticulocyte count and peripheral blood smear examination, biochemical investigations including serum bilirubin levels, lactate dehydrogenase levels, serum vitamin B12 levels (NR: 200 ? 950 pg/ml) and red cell folate levels (NR: 175 ? 700 ng/ml). Bone marrow was done to confirm the diagnosis in those children who could not afford B12 and folate levels. The diagnosis of megaloblastic anemia was established on the basis of serum Vitamin B12 levels below 200 pg/ml. and /or RBC folate levels below 175 ng/ml or bone marrow suggestive of megaloblastic changes along with the clinical findings and smear picture suggestive of megaloblastic anemia. All diagnosed cases were treated as per standard treatment guidelines for Megaloblastic anemia of Indian Academy of pediatrics. Results: A total of 1365 patients were referred to for anemia during the study period. Of these 56 (4.1%) children were diagnosed as per the predefined criteria as megaloblastic anemia. Among these children, the age and sex distribution was as follows: 25 (44.64%) were males 31 (55.35%) were females with male to female ratio of 0.8: 1. The youngest was 3 month old and the oldest was 12years old.22 (39.28%) of them were in age group of 0 to 12 months, 17 (30.3%) each belonged to age group of 1 to 6 years and 6 to 12 years group. When evaluating diet in these children, history of milk based diet was obtained in 24 (42.85%) children, 15 (26.78%) were lacto - vegetarian and17 (30.35%) consumed a mixed (non - vegetarian) diet. Clinical presentations varied from recurrent infections to various hematological manifestations including mucosal or skin bleeds.29 (51.78%) patients were incidentally found to have megaloblastic anemia on routine blood counts when they were seen for acute infections.12 (21.42%) had pallor as presenting complaint.5 (8.92%) children presented with skin and mucosal bleeds.10 (17.8%) of them presented with neurological complications; 4 (7.14%) of these had infantile tremor syndrome and the remaining 6 had developmental delay. On examination, pallor was present in all, hyperpigmented knuckles were seen in 37 (66.07%) children, whereas sallow complexion was found in 30 (53.57%) children.8 (14.2%) had icteris, 18 (32.1%) children had mild hepatosplenomegaly.20 (35.7%) patients had Severe Acute malnutrition, while 26 (46.42%) of them had moderate acute malnutrition. Only 10 (17.85%) children had a normal nutritional status. On investigations, hemoglobin ranged from 1.6gm% to 7.5gm% (mean Hb 5.7?1.02gm%). MCV ranged from 90fL to 123 fL (Mean MCV was 102.43?6.94 fL).14 (25.00%) children had pancytopenia and 18 (32.14%) had bicytopenia (anemia with leucopenia).6 (10.71%) patients who presented with mucosal and skin bleeds had thrombocytopenia (platelet counts ranged from 30, 000 to 50, 000 per c. mm). Peripheral blood smear showed macrocytes, macroovalocytes and pear shaped poikilocytes in all of them. Hypersegmentation and large sized neutrophils were seen in 21 (37.5%) cases. Serum bilirubin levels ranged from 0.4mg/dl to4.7 mg/dl (with high indirect bilirubin in those with elevated levels). Serum LDH levels>1000 IU/L was seen in as many as 34 (60.71%) children. Serum vitaminB12 and red cell folate levels could be done in 45 (80.35%) patients. Of these, 24/45 (53.33%) had low serum vitamin B12 levels, 8/45 (17.7 %) had low folate levels and 13/45 (28.8%) patients had normal levels.11 (19.64%) children were diagnosed on the basis of bone marrow aspirate findings of megaloblastic anemia. Treatment was effective in a short duration with a mean rise in hemoglobin of 1 to 2 gm% in the 1st week and by 4 to 4.3 gm% in 2nd week. Thrombocytopenia and other morphological parameters also showed improvement on treatment within 4 weeks.

Keywords: megaloblastic anemia, pediatric nutrition, vitamin B12 deficiency, neurological symptoms, treatment response

How to Cite?: Dr. Sujata Sharma, Dr. Suroor Makharia, Dr. Aashna Gupta, Prachi Pandhare, "Prevalence and Clinical Profile of Megaloblastic Anemia in Children", Volume 14 Issue 6, June 2025, International Journal of Science and Research (IJSR), Pages: 490-495, https://www.ijsr.net/getabstract.php?paperid=SR25604182053, DOI: https://dx.doi.org/10.21275/SR25604182053