Prevalence of megaloblastic anemia in patients at NIMS Hospital, Jaipur, Rajasthan

Abstract

Background: 

Anemia is defined operationally as a reduction in the hemoglobin content of blood that can be caused by a decrease in red blood corpuscles, hemoglobin, and hematocrit below the reference interval for healthy individuals of similar age, sex, and race under similar environmental conditions. Megaloblastic anemia is a condition, in which the bone marrow produces unusually large, structurally abnormal, and immature red blood cell. World Health Organization identifies anemia as the most common nutritional deficiency disorder in the world and a serious health concern among pregnant women. The 2011 estimates suggest that anemia affects around 800 million children and women all over the world, including 273 million children, 496 million non-pregnant women, and 32 million pregnant women.

Objective: 

To determine the prevalence of megaloblastic anemia in patients at NIMS Hospital, Jaipur, Rajasthan, India.

Materials and Methods: 

Blood was collected and investigations are done on Elite 580.

Results: 

Male patients were more likely than female individuals to have megaloblastic anemia. Only 62 patients were female, with 210 patients being men. Male patients made up 77.21% of the prevalence, while female patients made up 22.79%. Megaloblastic anemia is more common in people between the ages of 41 and 50, both in male and female patients. Between the ages of 41 and 50, there were 144 male patients and 35 female patients overall. According to their ages, the prevalence of mean ± standard deviation was 43.5 ± 15.6 years for male patients and 41.32 ± 6.53 years for female patients. Male patients with megaloblastic anemia had an average hemoglobin concentration of 9.990.94 g/dL, whereas female patients had one of 9.970.87 g/dL.

Conclusion: 

Government of Rajasthan as well as Health Ministry of India should take appropriate action to control the megaloblastic anemia in patient. Megaloblastic anemia is a common anemia found in the rural parts of Jaipur. The present study helps physicians to take necessary steps to control it. Not only for physicians, it will also be helpful for the government authorities to take appropriate steps to prevent and control the megaloblastic anemia. Iron and vitamin B12 supplements should be given to the patients on right time to control megaloblastic anemia. A balanced diet should be taken to prevent it. Government should take steps to educate the peoples of Rajasthan by displaying posters, conducting educational dramas, etc., both in rural and in the urban parts of this state.

Introduction

Anemia is defined operationally as a reduction in the hemoglobin content of blood that can be caused by a decrease in red blood corpuscles (RBCs), hemoglobin, and hematocrit below the reference interval for healthy individuals of similar age, sex, and race under similar environmental conditions.^[1,2]

Anemia can also develop as a result of acute blood loss (such as a traumatic injury) or chronic blood loss (such as an intermittently bleeding colonic polyp). Increased hemolysis results in a shortened RBC life span, thus increasing the risk for anemia. Chronic blood loss induces iron deficiency as a cause of anemia. With acute blood loss and excessive hemolysis, the bone marrow takes a few days to increase the production of RBCs.^[1-3]

Common types of anemia

Iron deficiency anemia

A lack of iron in your body is the main cause of this type of anemia. Iron is required by bone marrow to produce hemoglobin. Your body cannot produce enough hemoglobin for red blood cells without enough iron. Many pregnant women without taking iron supplements suffer with this type of anemia. It can also be brought on by blood loss from heavy monthly flow, stomach or small intestine ulcers, large bowel cancer, and regular use of various over-the-counter painkillers, particularly aspirin, which can irritate the stomach lining and lead to blood loss. To stop the anemia to recur, it is very important to identify the cause of the iron shortage.^[4]

Vitamin deficiency anemia

To make enough healthy red blood cells, your body also requires folate and vitamin B-12 in addition to iron. Reduced formation of red blood cells can result from a diet deficient in these and other essential nutrients. Some individuals who have enough B-12 cannot absorb the vitamin. Pernicious anemia, commonly known as vitamin deficiency anemia, may result from this.

Anemia of inflammation

Certain diseases—such as cancer, human immunodeficiency virus/acquired immunodeficiency syndrome, rheumatoid arthritis, kidney disease, Crohn’s disease, and other acute or chronic inflammatory diseases—can interfere with the production of red blood cells.

Aplastic anemia

This uncommon, potentially fatal anemia develops when your body fails to create enough red blood cells. Aplastic anemia can be brought on by hazardous chemical exposure, certain medications, autoimmune illnesses, and infections.

Anemias associated with bone marrow disease

Numerous conditions, including leukemia and myelofibrosis, can impact bone marrow function and result in anemia. The various types of cancers and cancer-like illnesses’ impact a range from non-existent to life-threatening.

Hemolytic anemias

When red blood cells are lost more quickly than bone marrow can produce new ones, this group of anemias form. Certain blood diseases increase RBC destruction. Hemolytic anemia can be inherited or acquired later in life.

Sickle cell anemia

This inherited and sometimes serious condition is known as hemolytic anemia. Red blood cells are forced to take on an unusual crescent (sickle) shape as a result of a faulty formation of hemoglobin. There is a persistent deficit of red blood cells as a result of these abnormal blood cells dying too soon.

Anemia caused by other diseases—some diseases can have an effect on the body’s potential to make red blood cells. For example, some patients with kidney disorder boost anemia due to the fact the kidneys are no longer making sufficient hormone erythropoietin to sign the bone marrow to make new or extra red blood cells. Chemotherapy used to deal with a variety of cancers frequently impairs the body’s capacity to make new red blood cells, and anemia regularly effects from this treatment.

Subjects and Methods

This investigation involved a cross-sectional study conducted at a tertiary care Hospital at Jaipur, Rajasthan, India. The participants were enrolled between January 2021 and June 2022.

Statistical analysis

The data were analyzed with SPSS 21.0, IBM SPSS Statistics for Windows, version 21.0 (IBM Corp., Armonk, N.Y., USA). Numerical variables are presented as the mean ± standard deviation (SD). Enumeration data and ranked data are presented as percentages. A P-value < 0.05 was considered statistically significant.

Ethics

The study was carried out in accordance with recommendations of the Clinical Research Ethics Committee of NIMS college of Paramedical Technology via letter number NIMS/IRC/PARA/MLT/2021/003. All parents provided written informed consent before the start of the studies.

Collection of venous blood

3 mL venous blood was with drawn from the patients in EDTA vial for hematological investigations.

Collection procedure

Apply a tourniquet to the upper arm sufficiently tight to restrict the venous flow and make the vein stand out. Sterilize the arm by swabbing the selected vein and site with 75% alcohol and allowed to dry. Prepare the syringe, usually a 21-gauge needle is appropriate for very fine veins, press just below the puncture site to anchor the vein. Insert the needle smoothly with the level facing upwards, at the angle of 30 degree to the surface of the arm, when the sufficient quantity of blood is collected, tourniquet is loosened and wed of cotton wool at the puncture site was placed while withdrawing the needle gently. Blood is dispensed in the sample tubes as required.

Complete blood count

The blood samples were analyzed using a Hematology Analyzer (Erba Elite 580) performing hematological analysis on whole blood collected in EDTA tubes.

Parameters

CBC: WBC, RBC, HGB, HCT, the mean corpuscular volume, the mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, the red cell distribution width-CV, the red cell distribution width-SD, PLT, MPV, PCT, platelet distribution width-SD, platelet distribution width-CV, P-LCR, P-LCC, DIFF: Neutrophils%, Lymphocytes%, Monocytes%, Eosinophils% and Basophils%, ALY%, LIC,% NLR.

Results

In Table 1, its shows that prevalence of megaloblastic anemia in male patients is 210 and that of female patients, the value is 62. Total number of patients diagnosed megaloblastic anemia is 272. Also, the percentage of male patients is 77.21% and female patients is 22.79%. Male patients have a high prevalence of megaloblastic anemia than female patients.

Table 1:: Prevalence of megaloblastic anemia by gender

Figures 1 and 2, the number of patients is 210 and 62 for male and female patients, respectively. The percentage is 77.21% and 22.79% for male and female patients, respectively.

Figure 1:: Prevalence of megaloblastic anemia by gender

Figure 2:: Prevalence of megaloblastic anemia by gender (%)

In Table 2, the prevalence of megaloblastic anemia according to age group is shown, between 31 and 40 years aged group, a total of 66 male patients and 27 female patients are found. So, in that case male patients are more in number than female patients. Between 41 and 50 years aged group, a total of 144 patients are men and only 35 are women. So, between 41 and 50 years aged group, the prevalence of megaloblastic anemia is higher in male than female patients.

Table 2:: Prevalence of megaloblastic anemia by different aged group

In Figures 3,4–5, it is shown that the number of male patients with megaloblastic anemia in the case of 31–40 years aged group was 66 and between 41 and 50 years aged group, the number was 127, whereas in the case of female patients, between 31 and 40 years aged group, the number was 27 and between 41 and 50 years aged group, it was 35.

Figure 3:: Prevalence of megaloblastic anemia by different aged group

Figure 4:: Pie diagram of megaloblastic anemia in 31–40 years age group

Figure 5:: Pie diagram of megaloblastic anemia in 41–50 years age group

In Table 3, it is shown that mean ± SD (in years) for male patients is 43.51 ± 6.53 year and for female patients it is 41.32 ± 6.53 year. So, male patients with older age diagnosed megaloblastic anemia as compared with female patients.

Table 3:: Mean ± SD of gender in year

In Figures 6,7–8, the mean and SD of age for male and female patients are shown. The mean ± SD is 43.51 ± 5.6 years for male patients, whereas it is 41.32 ± 6.53 year for female patients with megaloblastic anemia.

Figure 6:: Mean ± SD of age in year

Figure 7:: Mean ± SD (in years) of male patients

Figure 8:: Mean ± SD (in years) of female patients

In Table 4, it is shown that the mean ± SD of hemoglobin in male patients is 9.99 ± 0.94 g/dL and the mean ± SD of hemoglobin in female patients is 9.97 ± 0.87 g/dL. The level of hemoglobin in female patients is lower than male patients.

Table 4:: Mean ± SD of hemoglobin (in g/dL)

In Figures 9,10–11, mean ± SD of Hb shows and in the case of male patients, the value is 9.99 ± 0.94 g/dL and 9.97 ± 0.87 g/dL is for female patients with megaloblastic anemia.

Figure 9:: Mean ± SD of hemoglobin (in g/dL)

Figure 10:: Mean ± SD of hemoglobin (in g/dL) in male patients

Figure 11:: Mean ± SD of hemoglobin (in g/dL) in female patients

Discussion

In our present study, we found that the number of male patients with megaloblastic anemia was 210 and that of female patient was 62. The percentage was 77.21 and 22.79 for men and women, respectively. The prevalence of male patients was much higher than that of female patients. Our study resembled with the studies conducted by some researchers. So, according to Agrawal et al.,^[5] the prevalence of male patients was higher than female, and 70 were male patients and 30 were female patients, who were detected with megaloblastic anemia. According to Suthar and Shah,^[6] 66 male patients were megaloblastic anemia, whereas 34 female patients were under megaloblastic anemia. Our study also resembled like the study conducted by Bhatia et al.^[7]; in their study, they found that male patients were high in number than female patients, that is, 71 were male patients and 46 were female patients with megaloblastic anemia. But the results of our study were different from the studies conducted by some authors. So, according to Magnani et al.^[8] the prevalence of female patients was higher than that of male patients. 55.02% and 44.98% were the respective percentages of female and male patients. Similarly, the study conducted by Sharma,^[9] found that 71% female patients were megaloblastic anemia and in the case of male patients, only 29% were under the megaloblastic anemia. Mahmoud et al.,^[10] found that 80.3% of female patients came under megaloblastic anemia group and only 19.7% were male patients.

Our present study showed that the prevalence of megaloblastic anemia between 31 and 40 years age group was 66 in male patients and 27 in female patients, whereas, in 41–50 years age group, the number of male patients was 144, and 35 was for female patients. So, the prevalence was higher in 41–50 years age group both in male and female patients. Older aged patients have a high prevalence of megaloblastic anemia than younger ones. Our present study was in discordance with the study of Mangani et al.^[8] where prevalence of the megaloblastic anemia was higher in 21 to 30 years age group patients as compared to 31 to 40 year aged grouped patients. Also, a study conducted by Sharma,^[9] also opposed with our study and in her study, she found that age group between 10 and 30 years had more prevalence of megaloblastic anemia and it is 48%. Somehow, the study conducted by Suthar and Shah,^[6] sightly resembled with our present study. In their study, they found that the prevalence of megaloblastic anemia was high between 20 and 40 years of the patients and it is 22%. Also, the study conducted by Deepankar et al.^[11] found that 46% were megaloblastic anemia patients between 22 and 40 years age group.

Our study showed that the prevalence of megaloblastic anemia in male patients was 43.51 ± 5.6 years and that of the female patients was 41.32 ± 6.53 years. So, the difference was almost same for male as well as female patients. The result of our present study resembled with the study conducted by Mahmoud et al.,^[10] and they found in their study that mean ± SD of the patient with megaloblastic anemia was 39.77 ± 10.74 year, whereas, the study conducted by Magnani,^[8] concluded that mean ± SD was 27.55 ± 9.77 year. Similarly, according to Aarthi et al.,^[12] the prevalence of mean age was 29.69 ± 18.15 year. Both the studies opposed with our present study and they concluded that younger age patients had a high prevalence of megaloblastic anemia than older patients.

In our present study, it is shown that the level of hemoglobin in male patients was slightly higher than female patients. The value was 9.99 ± 0.94 g/dL in male and 9.97 ± 0.87 g/dL in female patients. Many researchers conducted studies about the mean value of hemoglobin, and unfortunately their results did not match with our present study. So, according to Gomber et al.^[13] found that mean ± SD of Hemoglobin in megaloblastic anemia was 5.32 ± 1.88 g/dL and according to Iqbal et al.,^[14] conducted an experiment and found that mean ± SD of hemoglobin in megaloblastic anemia was 6.4 ± 0.2 g/dL. However, both the studies do not resemble with the study conducted by us.

Conclusion

The present study was conducted in the Department of Paramedical and Technology, NIMS University, Jaipur (Rajasthan) between December 2021 and May 2022. A total of 272 positive samples were collected from IPD and OPD from NIMS Medical College and Hospital, Jaipur to analyze the prevalence of megaloblastic anemia in male and female patients. Our study found that:

• The prevalence of megaloblastic anemia in male patients was higher than female patients. 210 patients were men and only 62 patients were women.
• The percentage of prevalence in male patients was 77.21%, and for female patients, it was 22.79%.
• The prevalence of megaloblastic anemia was found to be high between 41 and 50 years age group of patients in both gender. A total of 144 patients were men and 35 were female patients between 41 and 50 years age group.
• The prevalence of mean ± SD for male and female patients according to their age was 43.51 ± 5.6 year for male patients and 41.32 ± 6.53 for female patients.
• The prevalence of hemoglobin in male patients was 9.99 ± 0.94 g/dL and 9.97 ± 0.87 g/dL for female patients with megaloblastic anemia.

Acknowledgments

We are grateful to the subjects who participated in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.