Etiological Profile of Macrocytic Anemia in Patients Attending a Tertiary Care Hospital in Nepal

Abstract

Introduction: The morphological classification of anemia often correlates with the cause of red cell deficiency. Megaloblastic and non-megaloblastic macrocytic anemias are important causes of anemia in at least 1.7% of hospital patients.  Vitamin B12 and folate deficiency are rampant in underdeveloped countries. In Nepal, there is a lack of local data evaluating the etiological profile of macrocytic anemia.

Methods: A descriptive hospital-based study was conducted, and thirty-five cases of anemia according to the WHO criteria were included after informed consent.  Clinical history, physical examination, complete hemogram (including hemoglobin level, red cell indices, total leucocyte count, platelet count, and reticulocyte count), and a peripheral blood smear were obtained per structured proforma. Appropriate biochemical investigations were acquired. Statistical analyses were performed as per standard statistical protocols.

Results: The mean age of the patients in our study was 42.40 (±10.29) years. There was a slight male predominance (n=20; 57.14%). Most cases (n=27;77.14%) of macrocytic anemia were megaloblastic. Vitamin B12 deficiency (n=13; 48.14%) was the commonest identifiable cause in megaloblastic group, while liver disease accounts for half of the cases (n=4; 50%) of non-megaloblastic group. The mean hemoglobin was lower (9.94±1.43 g/dl) in megaloblastic anemia compared to non-megaloblastic macrocytic anemia (10.96±1.24 g/dl). 

Conclusion: The present study showed that megaloblastic anemia was the most common cause of macrocytic anemia, primarily due to vitamin B12 and folate deficiency. Non-megaloblastic anemia was mainly attributed to liver diseases.