Clinico-hematologic profile of megaloblastic anemia in children


  • Sankeerth Yellinedi Department of Pediatrics, JJM Medical College, Davangere, Karnataka, India
  • Sandeep Karanam Department of Pediatrics, JJM Medical College, Davangere, Karnataka, India
  • Guruprasad Gowdar Department of Pediatrics, JJM Medical College, Davangere, Karnataka, India



Hyperpigmentation, Macrocytic anemia, Pallor, Vitamin B12 deficiency


Background: Megaloblastic Anemia is an important reversible cause of neurodevelopmental deterioration. The present study intended to describe the common presenting scenarios, clinical and haematological manifestations of the disease. The main objective of study is to describe the varied clinical and hematologic manifestations of Megaloblastic Anemia in children admitted to a tertiary care hospital, and to observe the mode of presentation of disease and its distribution among various age groups.

Methods: A Retrospective cross - sectional study was conducted in children between 6 months and 18 years, who were admitted with diagnosis of megaloblastic anemia from June 2010 to May 2015. Case records of eligible participants were analysed for primary outcome measures like presenting complaints, mode of diagnosis, peripheral smear findings, and clinical features and secondary outcome measures like age, sex, coexisting morbidities and nutritional status.

Results: Of a total of 129 cases, in 58% subjects, diagnosis was confirmed by Vitamin B12 assay, 42% were diagnosed by bone marrow examination. Macrocytic anemia was observed in peripheral smear examination in 100% subjects. Hyperpigmentation was noticed in 78% of subjects. Blood transfusion secondary to severe anemia was needed in 79% of subjects. Anorexia, generalised weakness, pallor was observed in 100% subjects, neurologic manifestations in 38% subjects.

Conclusions: The most common presenting complaint in megaloblastic anemia due to Vitamin B12 deficiency is anorexia, generalised weakness, irritability manifesting clinically as pallor, hyperpigmentation and haematologically as macrocytic anemia with bicytopenia. Regular report of common presentations of megaloblastic anemia in various age groups keeps the child care expert vigilant for its early detection.


Michael W, David R, Cooper B. Megaloblastic anemia. Nathan and Oski’s Hematology of Infancy and Childhood 7th edition Saunders . 2014:419-21.

Sally S. Clinical Practice :Vitamin B12 Deficiency. The New England Journal Of Medicine. 2013;368:149-60.

Sarah D, Veronica HF, Julie P, Paul S, Amanda B. Vitamin B12 Deficiency:The Great Masquerader. Pediatric Blood Cancer. 2014; 61:753-5.

Proytcheva M. Bone marrow evaluation for paediatric patients. International Journal of Laboratory Haematology. 2013;35:283-9.

Zengin E, Sarper N. Clinical manifestations of infants with nutritional vitamin B12 deficiency due to maternal dietary deficiency. Acta Pediatrica. 2009;9:98–102.

Faruk I, Ozlem HM, Sakir Altunbasak, Goksel L.Neurologic findings of nutritional vitamin B12 deficiency in children. The Turkish Journal of Pediatrics. 2010;52:17-21.

Sunil G, Kusum K, Dhingra N. Clinico-Hematological Profile of Megaloblastic Anemia. Indian Pediatrics. 1998;35:55-8.

Lee SH, Lee WS, Whang KC, Lee SJ, Chung JB. Hyperpigmentation in megaloblastic anemia. Int J Dermatol. 1988;27(8):571-5.

Meghann P, Andrew W, Pancytopenia in Hospitalized Children A Five-year Review. Journal of Pediatric Hematology and Oncology. 2010;32(5):e192-4.

Norma BL. Megaloblastic anemia. Nelson Textbook of Pediatrics 20th edition. Elsevier. 2015:2319 – 21.

Anupam Sachdeva. Nutritional Anemia. In Practical Pediatric Hematology. 2nd edition Jaypee. 2012.






Original Research Articles