ISSN - 0973-0958

Pediatric Oncall Journal

An 11 year old girl with recurrent megaloblastic anemia

An 11 year old girl with recurrent megaloblastic anemia

Dr Ira Shah.
Medical Sciences Department, Pediatric Oncall, Mumbai, India.

Dr Ira Shah, Medical Sciences Department, Pediatric Oncall, 1, B Saguna, 271, B St. Francis Road, Vile Parle {W}, Mumbai 400056.
Clinical Problem
11 years old girl was referred for recurrent anemia. One month back, she was hospitalized for anemia, high colored urine and anorexia. Her investigations showed Hemoglobin of 5.4 gm%, (MCV =132, MCH = 45) with reticulocyte count of 5.3%. Her serum bilirubin was 2.5 mg% (1.7 mg % Indirect Bilirubin). A hemolytic work-up was done which was normal. (Osmotic fragility – Normal, DCT was negative, Hemoglobin electrophoresis was normal). Patient was on a vegetarian diet of only on dal & rice. She was diagnosed as Megaloblastic anemia and discharged on Folic Acid, Vitamin B12 and multivitamins. A year later, her hemoglobin was 13.5 gm%. Folic Acid and Vitamin B12 were omitted. Again in 6 months, she complained of easy fatigability and anorexia. Her hemoglobin was 6.8 gm% (MCV = 113, MCH =38.3). Bone marrow aspiration was done that showed megaloblastic changes with giant myelocytes and normal megakaryocytes. Serum B12 levels were 50.0 pg/ml [Normal 250-950 pg/ml] and serum folic Acid was 5.5 ng/ml [Normal 3-17 ng/ml].

Why is the child having recurrent megaloblastic anemia?
Recurrent megaloblastic anemia in an older child could be due to poor nutritional diet or could be due to deficiency of Intrinsic factor (Juvenile Pernicious anemia). This child had a response to supplements of B12 and her hemoglobin rose with that so it rules out an Intrinsic factor deficiency. Nutritional anemia is a possibility as the child a poor intake of B12 and a diet that is vegetarian without any green vegetables or fruits. This child has NUTRITIONAL MEGALOBLASTIC ANEMIA. Thus apart from B12 supplementation she would require a dietary modification. Her anemia did improve with diet modification.

Hence while dealing with a dietary disorder, it is imperative that not only one gives supplements but also advocates diet modification to ensure no relapse of the condition as was seen in this case.
Compliance with ethical standards
Funding:  None  
Conflict of Interest:  None
Cite this article as:
Shah I. An 11 year old girl with recurrent megaloblastic anemia. Pediatr Oncall J. 2006;3: 22.
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