Abstract

Introduction

Most common cause of pancytopenia is Megaloblastic anemia, followed by acute myeloid leukemia and aplastic anemia. Bone marrow examination is a single useful investigation which reveals the underlying cause in patients with pancytopenia.^[1]

Folic acid and cobalamin are B-group vitamins that play an essential role in many cellular processes. Deficiency in one or both of these vitamins causes megaloblasticanaemia, a disease characterized by the presence of megaloblasts.

Iron deficiency anemia (IDA) is the most common nutritional deficiency disorder in both developing and developed countries and it was reported that more than 500 million people worldwide are estimated to have IDA ^[2,3].

IDA is the most common type among all other anemia and it happens when the bodydoesn’t have enough iron to make hemoglobin. Iron deficiency is an end result of prolonged negative iron balance, mainly due to poor dietary availability, rapid growth of the person, and blood loss due to heavy periods, ulcers, in the blood and in terms of public health anemia is defined as the low concentration of hemoglobin i.e. <12 gm%^[4]. Iron deficiency affects more people than any other condition, constituting a colon polyps, or colon cancer. Sometimes, pregnancy can also cause IDA if there is not enough iron for the mother and fetus^[5]. The pathophysiological changes in IDA are categorized into three stages. The first stage involves pre-latent deficiency where liver, spleen and bone marrow show reduced iron stores; second stage shows latent deficiency which is the condition with very low or absent bone marrow iron stores and there is a progressive reduction in plasma iron (bone marrow iron is absent, serum ferritin is <12μg/l, transferrin saturation is <16% and free erythrocyte porphyrin is increased) however, hemoglobin concentration remains normal; and finally IDA is a very late stage of iron deficiency with progressive fall in hemoglobin levels and mean corpuscular volume^[6].