Background and Aims: Subclinical Vitamin B12 deficiency is a very common entity in the Indian subcontinent with devastating clinical and socio-economic consequences. The objective of this study was to estimate the proportion of vitamin B12 deficient children and to evaluate their clinical profile. Setting and Design: This prospective analytical study was conducted in a tertiary level care institute in Northern India. Materials and Methods: Children with clinical pallor, were included in this study. Detailed history, height, weight percentiles and characteristic features of vitamin B12 deficiency were recorded and complete blood counts, mean corpuscular volume and vitamin B12 levels were done. Statistics: For Qualitative data was analyzed using Pearson Chi square tests and quantitative data was analyzed using two sided independent samples t tests. Results: A total of 111 children were included. 64.8% ( n = 72) had vitamin B12 deficiency. Lethargy (63.9%) and weight loss (62.1%), Knuckle pigmentation were common features. One-fourth of the children were on vegetarian diet. Neurological manifestations were significantly associated with fragile hair ( p 0.056) and knuckle pigmentation ( p 0.027). Younger children had more weight loss ( p 0.001), knuckle pigmentation ( p 0.019) and hypotonia ( p 0.045). One fifth of children presented with neurological manifestations. Conclusions: Two-thirds of the anemic children had vitamin B12 deficiency. There was a bimodal age distribution with regard to B12 deficiency. Neurological manifestations were predominant in younger children [<6] and hematological abnormalities were more frequent in older children [≥6 years]. Estimation of vitamin B12 levels forms an essential component while evaluating children with anemia, despite mixed dietary habits and normal MCV.

Transient abnormal myelopoiesis (TAM) is a hematological disorder, which is rare but unique for children with Down syndrome. It is important to diagnose this entity, as these children are at 500 times higher risk for the development of acute myeloid leukemia (AML) later in life. We report a late-preterm, low birth weight, female baby born to a 35-year-old G 4 P 2 L 2 A 1 mother. The baby was diagnosed to have down's phenotype at birth. On the day one of life, the baby had leukocytosis with increased peripheral blast cells. On 23 rd day of life, there was a resolution of leukocytosis and the disappearance of blast cells. The child has been under regular follow-up since then. As these children are at a high risk for the development of AML in later life, a hemogram with total leukocyte counts and differential count should be a part of neonatal follow-up.

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