Original Article

Prevalence of megaloblastic anaemia and its causative

factors in a tertiary care centre at Western India
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ABSTRACT
Background: Anaemia affected population includes male, females as well as children and is a common problem that has been seen in western
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 10/20/2023

India. Megaloblastic Anaemia is common in India but regarding its prevalence and causative factors data is insufficient. The most common cause
of megaloblastic anaemia includes deficiency of folic acid and Vitamin B12. Due to vegetarian lifestyle of the people the deficiency of Vitamin
B12 is more common rather than the other macronutrient. In today’s time, only iron and folic acid is provided by Anaemia control or prophylaxis
program. This issue needs focus and hence this study has been chosen.
Objective: To focus on the incidences of Megaloblastic Anaemia in Western India and analyse the possible causative factors.
Materials and Methods: Patients with a haemoglobin <10 g/dl and peripheral smear findings consistent with megaloblastic anaemia
present in the hospital over a period of 2 months will be included in the study. Patient’s diet, drug intake, present symptoms and other history
will be taken into account. Recording of complete blood counts, peripheral film examination, reticulocyte count and cobalamin and folate assays
will be done. Patients suffering from chronic disease like renal disease, cancer, tuberculosis, liver disease etc., Will be excluded from the study.
All data will be collected and statistically evaluated.
Results: In the current study, 500 patients who were admitted to the gynaecology, paediatric, and medical wards were all assessed. These
patients were all eligible to participate. They were divided into three groups based on the mean corpuscular volume (MCV) value, serum assay,
and peripheral smear results: Macrocytic, normocytic, and microcytic anaemia. A megaloblastic blood film or low serum indicators along with the
normal MCV value were categorised as having macrocytic anaemia. A total of 100 patients had macrocytic anaemia identified. The distribution of
sexes was: 70 (male), 30 (female). There were discovered to be 55% of patients with cobalamin deficit and 8% of patients with folate deficiency.
Every patient were vegetarians, coming from a poor socioeconomic status.
Conclusion: The diagnosis of Megaloblastic anaemia was done through complete blood counts, red cells and assays of two vitamins. Majority
of patients having megaloblastic anaemia was due to deficiency of cobalamin. Poor diet in cobalamin or folate were the contributing factors in
Megaloblastic anaemia. Prevention can be done through awareness camps and education programmes and also through proper diet. Vitamin
B12 should be included in the diet of patients along with iron and folic acid.

Keywords: Folic acid, haemoglobin, macrocytic, microcytic, normocytic, Vitamin B12

Atul Khajuria, Rakesh Das1

Department of Medical Laboratory Technology, NIMS College
INTRODUCTION
of Paramedical Technology, NIMS University, 1Technical Officer
Medical Laboratory Technology, NIMS College of Paramedical
India is country with diverse population different food habits
Technology, Jaipur, Rajasthan, India
and sociocultural norms. The problem of Megaloblastic
anaemia has not properly been recorded. From the public Address for correspondence: Prof. Atul Khajuria,
NIMS College of Paramedical Technology, NIMS University, Jaipur,
health point of view deficiency of Vitamin B12 and folate Rajasthan, India.
has added a little to nutritional Anaemia. Various workers E‑mail: atul.khajuria@nimsuniversity.org, atulkhajuria83@gmail.
com
has presented this issue but of no use. This study has been
choosen to focus on this issue. Submitted: 25‑Nov‑2022 Revised: 28-Nov-2022
Accepted: 29‑Nov‑2022 Published: 11-Jan-2023

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DOI:
How to cite this article: Khajuria A, Das R. Prevalence of megaloblastic
10.4103/sujhs.sujhs_41_22 anaemia and its causative factors in a tertiary care centre at Western India.
Santosh Univ J Health Sci 2022;8:141-4.

© 2023 Santosh University Journal of Health Sciences | Published by Wolters Kluwer - Medknow 141
 Khajuria and Das: Megaloblastic anemia and causative factors

In Western India the most common problem encountered is
Anaemia. Thomas Addison in 1849 atrributed the first clinical
description of pernicious Anaemia which is one of the known
cause of Megaloblastic anaemia. Megaloblastic anaemia s
caused due the abnormal maturation of haematopoietic
cells due to the fault in DNA synthesis. Two vitamins i.e.,
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and microcytic anaemia [Table 1]. The normal MCV value was
regarded as macrocytic anaemia if there was a megaloblastic
blood film or low serum markers.
Macrocytic anaemia was identified in a total of 100
individuals.

cobalamin (Vitamin B12) and folic acid are essential for DNA
biosynthesis. Hence deficiency of Folic acid and Vitamin
B12 are the most common cause of Megaloblastic anaemia.
Nowadays due to vegetarian lifestyle of the people Vitamin
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The distribution of sexes was 70 (male), 30 (female). Patients
with cobalamin insufficiency made up 55% of the population,
whereas those with folate deficiency made up 8% [Table 2]. All

B12 is most common.
Large amount of cobalamin can be stored in our body and the
diet of people living in Western India includes more amount
of cobalamin which is enough to meet the requirements.
Hence it can take 2–5 years to develop this deficiency.
Synthesis of cobalamin is done by bacteria and can be found
ion contaminated water and in soil. Dietary sources includes
food originating from animals i.e., meat, eggs, milk etc.
of the patients were vegetarians from lower socioeconomic
classes and the middle class.
Presentation
Neurological problems (50%) and fatigue were the main
symptoms (38%) Low grade fever, gastroenteritis, and
anorexia Palpitation was diagnosed in a total of 100 cases.
RESULTS FROM THE LAB

Animal products are not consumed by the people who are
vegetarian which develop deficiency of Vitamin B12. It is also
found that the only source of Vitamin B12 for vegeterians is
through the food that is contaminated by microorganisms.
Hence, Vitamin B12 defficiency increases in adults and
in children who are breastfeeded by vegan mothers. The
megaloblastic affected population includes males, females,
and also children.
The MCV varied from 70 to 128 fL.
Macro‑ovalocytes, tear drop cells, basophilic stippling,
polychromasia, hyper segmented neutrophils, or pancytopenia
were found in the peripheral smear. Blood transfusions for
anaemia were given to 30 individuals.
DISCUSSION

MATERIALS AND METHODS Megaloblastic anaemia is a diverse set of illnesses with similar
blood abnormalities and signs and symptoms. A unique
The study is both prospective and retrospective. All patients bone marrow morphology affecting erythroid, myeloid, and
who arrived at our Hospital for a period of 2 months, had a platelet precursors is present along with the macrocytic
haemoglobin peripheral smear findings that are consistent with anaemia, which is typically accompanied by leukopenia,
thrombocytopenia, and other symptoms.[1-5] A lack of folate
10 g/dl The study included people with anaemia. Diet, drug use,
or cobalamin (Vitamin B12) is the main cause of megaloblastic
and existing symptoms, previous blood transfusions, and other
anaemia.
History that was pertinent was taken into account. Complete
assessment of peripheral films, reticulocytes, and blood counts
Table 1: Distribution of various anaemia type
Assays for count, cobalamin, and folate were noted. Patients
Type of anaemia Number of patient present
with long‑term illnesses like cancer, renal disease, the study
Normocytic 50
eliminated those who had tuberculosis, hepatic illness, etc. Macrocytic 100
Microcytic 350
RESULTS Total 500

Five hundred patients in all who were admitted to the Table 2: Megaloblastic anaemia distribution based on
medical, paediatric, and gynaecology wards were assessed contributing factors
for the current study. Deficiency of factor Present Percentage
Pure cobalamin insufficiency 55
These patients were all eligible to participate. They were Pure folate insufficiency 100
divided into three groups based on the MCV value, serum Combined deficiency 8
assay, and peripheral smear results: macrocytic, normocytic, Unknown 29.7

142 Santosh University Journal of Health Sciences | Volume 8 | Issue 2 | July-December 2022
 Khajuria and Das: Megaloblastic anemia and causative factors
Megaloblast was initially used by Paul Ehrlich in 1880 to
refer to the aberrant cells found in a patient’s bone marrow
who had pernicious anaemia. The most well‑known kind of
megaloblastic anaemia, pernicious anaemia, was first identified
by Thomas Addison in 1855. The condition was referred to for
a while as Addisoniananaemia.[6] \s. The phrase “pernicious
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anaemia” was originally used by Anton Biermer in 1872.
Minot and murphy originally recognised Vitamin B12 as the
extrinsic source of energy in the 1920s.[1-5]
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According to Markle and Okuda’s review, the liver contains
a substance called Megaloblastic anaemia that alleviates the
signs and symptoms of pernicious anaemia. In 1948, the
chemical was purified and given the name Vitamin B12.[1-5]
In 1950, Hodgkin et al. [7] discovered the crystalline
structure of the Vitamin B12 molecule. The term
“Vitamin B12” refers to a class of chemically categorised
cobalamins that have physiological activity. A purine
nucleotide (5,6‑dimethylbenzimidazole) is connected to the
central cobalt atom of the corrin’s fundamental structure,
which is a tetrapyrrole ring.[7]
Megaloblastic anaemia is becoming more common, yet
hard evidence may be difficult to find. It can be difficult to
diagnose a Vitamin B12 deficiency. No one laboratory test
serves as a gold standard, and there are no standardised
diagnostic criteria.
For the diagnosis of this anaemia, a number of criteria have
been utilised in the literature, including the presence of
Megaloblastic alterations in the bone marrow and subnormal
levels of micronutrients. In less than a decade at one
location, macrocytic anaemia cases increased by almost a
factor of four, from 2.5% in 1991 to 7.8% in 1999,[8] according
to Khurshid A et al.[8] According to a recent study, 46.9% of
nonanemic adult individuals had subnormal levels of Vitamin
B12 or folate, with Vitamin B12 deficiency being five times
more common than folate deficiency. According to a study
from Mexico, folate deficiency was not seen, however B12
deficiency was found in 19%–41% of different population
groupings.[9] Another study on nursing moms in Guatemala
found that 46% had B12 deficiency, compared to 9% who
had folate deficiency.[10] B12 deficiency was found in almost
50% of Megaloblastic anaemia patients from Pakistan and
Zimbabwe, but folate deficiency was only identified in 8%
and 17% of cases, respectively.
B12 deficiency was found in nearly 85% of instances of
Megaloblastic anaemia, according to Nykjaer A et al.[11] from
Santosh University Journal of Health Sciences | Volume 8 | Issue 2 | July-December 2022
Chandigarh. The same result was noted by Hesdorffer et al.,[12]
Stouten K et al.,[13-15] and a number of other researchers. In
1998,[15] Gomber S. et al. conducted a study on the prevalence
and cause of nutritional anaemia in young children in an
urban slum.[16] For the purpose of assessing the prevalence
of nutritional anaemia, 300 children between the ages of
3 months and 3 years were randomly chosen and their data
analysed over the course of a year. 41.4% of children with
anaemia had pure iron deficiency anaemia (IDA). Children
who were anaemic were found to have deficiencies of Vitamin
B12 alone or in conjunction with iron in 14.4 and 22.2% of
cases, respectively.[17-20]
Regardless of the origin, nutritional macrocytic anaemia
currently seems to be more frequently caused by Vitamin B12
deficiency than by folate deficiency. Only iron and folic acid
are provided under India’s national nutritional programme
for the prevention or control of anaemia. The rise in cases
of Vitamin B12 insufficiency, which requires explanation,
is highlighted by the numerous research conducted in the
past and the current study.[17-20] The burden of Vitamin B12
deficiency should be recognised by the government, and it
should be addressed in the anaemia control programme.
Along with iron and folic acid, the Vitamin B12 tablet should
be given out. The addition of Vitamin B12 to food is another
choice that may be taken into account. By doing so, it may be
possible to reduce the prevalence of Vitamin B12 deficiency
and the level of subclinical Vitamin B12 deficiency. A few
employees have proposed that Vitamin B12 fortification
of foods may not be as successful due to malabsorptive
problems.[17-20] However, in India, poor diet rather than
absorption is the primary factor.
CONCLUSION
Megaloblastic anaemia is the second most common kind of
anaemia after IDA. There is a dearth of information regarding
the scope of the issue in Rajasthan’s Hadoti region and the
variables that can affect it. Megaloblastic anaemia brought
on by a Vitamin B12 deficiency is linked to other systemic
symptoms, and the morbidity is higher. Only iron and folic acid
deficiency is addressed by our anaemia control programme.
The national nutritional programme has to include Vitamin
B12, particularly in the area where the majority of people eat
vegetarianism. In their differential diagnosis of anaemia, the
doctor must include Vitamin B12 insufficiency.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
143
 Khajuria and Das: Megaloblastic anemia and causative factors
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