Hemorrhagic manifestation of megaloblastic anemia: report of two cases and literature review

Masoodi, Ibrahim; Kakar, Atul; Byotra, S.P.; Sachdev, Munish K; Hussain, Shabnum

doi:10.1097/mbc.0b013e328343f8eb

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…There are many studies and case reports regarding vitamin b12 deficiency with thrombocytopenia and bleeding manifestations. [21][22][23][24] However few studies did found thrombocytopenia in patients with vitamin b12 deficiency but it was not significantly associated. 25,26 Marwaha RK, et al reported 10 children with megaloblastic anemia and a hemorrhagic diathesis .…”

Section: Discussionmentioning

confidence: 99%

To determine the various causes of thrombocytopenia and its clinical correlation with bleeding in children and adolescents

Mishra,

Dwivedi

2023

PJMS

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Thrombocytopenia refers to a reduction in platelet count below 1,50,000/cumm. It is the most common cause of defective primary hemostasis that can lead to significant bleeding in children. It was a retrospective observational study conducted in a tertiary care hospital in Bhilai, chattisgarh between Augusts to December 2021. Data collection was done from Sept 2018-Sept 2019. The aim of present study was to determine the various causes of thrombocytopenia in children and adolescents and to correlate its severity with etiology and risk of bleeding. Total 112 patients were included from age group 1y-18 yrs. Out of total 112 patients 59 were males and 53 were females. 27 patients were 1-5 years of age, 30 patients were 6-12 years of age and55 were 13-18 years. The mean platelet count in my study was 68,340/cumm with a minimum of 4000/cumm. Bleeding was present in total 19 (16.9%) patients. The main bleeding manifestations were petechie or purpurae, epistaxis, ecchymosis, gastrointestinal bleed and others. Severity of thrombocytopenia correlates significantly with risk of bleeding (The p-value is 0.001**). The most common cause of thrombocytopenia in 69 patients with fever were infective and 43 patients without fever it was vitamin b12 deficiency. Severity of thrombocytopenia (p=0.0528) and bleeding (p=0.121) in patients with fever and without fever was not significant. Thrombocytopenia in pediatric and adolescent children is caused by both infective and non infective illness. It mainly presents with cutaneous bleeds and mucosal bleeds. Severity of thrombocytopenia is significantly correlated with bleeding.

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Section: Discussionmentioning

confidence: 99%

To determine the various causes of thrombocytopenia and its clinical correlation with bleeding in children and adolescents

Mishra,

Dwivedi

2023

PJMS

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“…Hemorrhagic events such as retinal hemorrhages and purpuric spots have been reported in patients with megaloblastic anemia caused by vitamin B12 deficiency. Bleeding in the form of hematemesis, hemoptysis, and even life-threatening bleeding have also been reported [ 11 ]. Interestingly, Saloujin et al reported that, in cases of megaloblastic anemia caused by vitamin B12 deficiency, the function of platelets is deteriorated [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

An infantile case of hereditary folate malabsorption with sudden development of pulmonary hemorrhage: a case report

et al. 2022

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Background Hereditary folate malabsorption—a rare disorder caused by impairment of the folate transporter—can develop into severe folate deficiency manifesting as megaloblastic anemia and occasionally thrombocytopenia. Reportedly, megaloblastic anemia can manifest with hemorrhagic episodes, possibly due to ineffective platelet production and platelet dysfunction. However, life-threatening hemorrhage events in hereditary folate malabsorption have not been well investigated. Case presentation A 3-month-old Japanese boy was transferred to our hospital due to thrombocytopenia and severe megaloblastic anemia. During a thorough examination of hematopoietic abnormalities, the patient suddenly went into cardiac arrest due to pulmonary hemorrhage. Although intravenous folate supplementation was started soon after the identification of folate deficiency, the patient died of circulatory defect and multiple organ failure. The cause of pulmonary hemorrhage, such as respiratory infection, could not be confirmed. Genetic investigation revealed a mutation in the SLC46A1 gene to be the cause of the hereditary folate malabsorption. Conclusion We report an infantile case of hereditary folate malabsorption that progressed to lethal pulmonary hemorrhage before folate deficiency was identified. Clinicians should consider that megaloblastic anemia could lead to severe bleeding without warning, and that nutrient supplementation should be initiated as soon as possible.

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“…The human body requires folic acid (FA) to produce blood cells, secure cell division, and growth [1,2]. Numerous studies have shown that this vitamin is important in the prevention of neurodegenerative diseases, cancer, and cardiovascular disease (CVD) [3,4].…”

Section: Introductionmentioning

confidence: 99%

Influence of folic acid supplementation on coagulation, inflammatory, lipid, and kidney function parameters in subjects with low and moderate content of folic acid in the diet

et al. 2015

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Hemorrhagic manifestation of megaloblastic anemia: report of two cases and literature review

Cited by 3 publications

References 5 publications

To determine the various causes of thrombocytopenia and its clinical correlation with bleeding in children and adolescents

To determine the various causes of thrombocytopenia and its clinical correlation with bleeding in children and adolescents

An infantile case of hereditary folate malabsorption with sudden development of pulmonary hemorrhage: a case report

Influence of folic acid supplementation on coagulation, inflammatory, lipid, and kidney function parameters in subjects with low and moderate content of folic acid in the diet

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