Title: Bleeding Diathesis: When Do We Suspect Vitamin B12 Deficiency?
Authors: Dr Sushant Mane, Dr Sonali Singh, Dr Swapnil Kumar, Dr Dattatray Pandurang Shinde
DOI: http://dx.doi.org/10.18535/jmscr/v4i3.32
Megloblastic anemia is uncommon in pediatric age group. It is most commonly due to vitamin deficiencies or gastrointestinal disorders. Megaloblastic anemia due to Dietary vitamin B-12 deficiency in infants is very rare but may be seen in breastfed infants whose mothers are B-12 deficient. Sometimes absence of carrier protein, transcobalamin, may present with megaloblastic anemia in early infancy. These infants if not treated promptly may develop myelopathy and developmental delay. Other children may sometimes present with bleeding diathesis secondary to qualitative and quantitative defects of platelets and sometimes pancytopenia. We present here a case of 8 year old girl who presented to us solely with ecchymosis and subcutaneous haematomas. Her blood picture showed bicytopenia with high MCV pointing towards the diagnosis of Megaloblastic Anemia. Bone marrow biopsy confirmed the diagnosis. She was given intramuscular methylcobalamine for 2 weeks followed by oral methylcobalamine and folic acid. Keywords: Megaloblastic Anemia, Bleeding Diathesis, Bone Marrow Biopsy, Methylcobalamin & Folic acid. 1. Hoffman R, Benz EJ, Furie B, Shattil SJ. Hematology: Basic Principles and Practice. Philadelphia, Pa: Churchill Livingstone; 2009. 2. Wang YH, Yan F, Zhang WB, et al. An investigation of vitamin B12 deficiency in elderly inpatients in neurology department. Neurosci Bull. 2009 Aug. 25(4):209-15. 3. Dali-Youcef N, Andres E. An update on cobalamin deficiency in adults. QJM. 2009 Jan. 102(1):17-28. 4. Tilak V, Jain R. Pancytopenia--a clinico-hematologic analysis of 77 cases. Indian J Pathol Microbiol. 1999 Oct;42(4):399-404. PubMed PMID: 11127368. 5. Khunger JM, Arculselvi S, Sharma U, Ranga S, Talib VH. Pancytopenia-A Clinico-hematological study of 200 cases. Indian J Pathol Microbiol.2002;45:375–9. 6. Anitha P, Sasitharan R, Thambarasi T, et al. Vitamin B12 deficiency presenting as pancytopenia and retinopathy in a young boy—Helicobacter pylori, a novel causative agent. The Australasian Medical Journal. 2014;7(3):143-148. doi:10.4066/AMJ.2014.1872. 7. Zhang Q, Lv X-Y, Yang Y-M. Megaloblastic anemia with hypotension and transient delirium as the primary symptoms: report of a case. International Journal of Clinical and Experimental Medicine. 2015;8(10):18879-18883. 8. Premkumar M, Gupta N, Singh T, Velpandian T. Cobalamin and Folic Acid Status in Relation to the Etiopathogenesis of Pancytopenia in Adults at a Tertiary Care Centre in North India. Anemia. 2012;2012:707402. doi:10.1155/2012/707402. 9. Metz, J. (1963). Folates in megaloblastic anaemia. Bulletin of the World Health Organization, 28(4), 517–529. 10. CHANARIN I, MOLLIN DL, ANDERSON BB. Folic acid deficiency and the megaloblastic anaemias. Proc R Soc Med. 1958 Sep;51(9):757-63. PubMed PMID:13591299; PubMed Central PMCID: PMC1889819.Abstract
References