Anemia remains a major global public health problem, adversely affecting health, social well- being, and economic development in both developing and developed countries.⁽¹⁾ Megaloblastic anemia is a common form of anemia in developing nations such as India.⁽²⁾ The first clinical description of pernicious anemia, a known cause of megaloblastic anemia, was provided by Thomas Addison in 1849.

Megaloblastic anemia results from impaired DNA synthesis leading to defective maturation of hematopoietic cells. Vitamin B12 (cobalamin) and folic acid are essential for DNA biosynthesis, and their deficiency constitutes the most common cause of this condition.⁽³⁾ Impaired DNA synthesis leads to nuclear–cytoplasmic asynchrony in erythroid precursors, resulting in characteristic hematological features such as macro-ovalocytes, hypersegmented neutrophils, and frequently pancytopenia.⁽¹⁾ Macrocytosis is often detected incidentally on automated cell counters, and evaluation of clinical, biochemical, and hematological parameters helps establish the diagnosis.⁽⁴⁾ In India, the high prevalence of vegetarian dietary practices contributes significantly to vitamin B12 deficiency.⁽³⁾ Megaloblastic anemia is a reversible cause of neurodevelopmental and neurological impairment if diagnosed and treated early.⁽⁵⁾

AIM:

To evaluate the clinical and hematological profile of patients diagnosed with megaloblastic anemia in a tertiary care hospital.

OBJECTIVES:

1. To study the demographic profile (age and gender distribution) of patients diagnosed with megaloblastic anemia.
2. To evaluate the clinical presentation, including symptoms and physical findings, in patients with megaloblastic anemia.
3. To assess the socioeconomic and dietary factors associated with megaloblastic
4. To analyze the hematological parameters and severity of anemia in affected
5. To determine the overall clinical–hematological profile of megaloblastic anemia in a tertiary care hospital setting.

MATERIAL AND METHODS

This was an observational, descriptive, cross-sectional study conducted in the Department of Pathology at P.D.U. Medical College and Hospital, Rajkot, over a period of three months from August 2025 to October 2025. The study included 100 patients who presented with hemoglobin levels less than 10g/dL and peripheral blood smear findings suggestive of megaloblastic anemia.

All eligible patients meeting the inclusion criteria during the study period were enrolled. Detailed case records were reviewed and analyzed to obtain demographic and clinical information, including age, gender, socioeconomic status, dietary habits (vegetarian or mixed diet), presenting symptoms, and clinical signs. Particular attention was given to symptoms such as generalized weakness, fatigue, pallor, dyspnea on exertion, giddiness, loss of appetite, neurological symptoms, icterus, and hepatosplenomegaly.

Peripheral blood smear examination was carried out in all cases to identify morphological features consistent with megaloblastic anemia, such as macro-ovalocytes, anisopoikilocytosis, and hypersegmented neutrophils. The severity of anemia was classified based on hemoglobin levels.

Patients suffering from chronic disease like renal disease, cancer, tuberculosis, liver disease etc., will be excluded from the study to avoid confounding factors.

The collected data were compiled and analyzed to assess the clinical and hematological profile of patients diagnosed with megaloblastic anemia.

RESULTS

The highest incidence of megaloblastic anemia in the present study was observed in the age group of 11–30 years, accounting for 49% of the total cases (Table 1).

A slight female preponderance was observed in the present study, with females constituting 56% of the 100 patients diagnosed with megaloblastic anemia (Table 2).

Megaloblastic anemia was more commonly observed among patients belonging to the lower socioeconomic status, accounting for 61% of the cases in the present study (Table 3).

In the present study comprising 100 cases of megaloblastic anemia, generalized weakness (92%) and pallor (88%) were the most common presenting features. These were followed by dyspnea (54%) and giddiness (46%). Neurological manifestations (26%), icterus (18%), and hepatosplenomegaly (12%) were observed less frequently (Table 4).

Among the 100 cases of megaloblastic anemia, the majority of patients (68%) were vegetarians, while 32% were non-vegetarians, suggesting a higher prevalence of the condition among individuals adhering to a vegetarian diet (Table 5).

According to the World Health Organization (WHO) guidelines, anemia is classified based on hemoglobin (Hb) levels as mild anemia when Hb is slightly below the normal reference range, moderate anemia when Hb is between 7–10g/dL, and severe anemia when Hb is less than 7g/dL. In the present study of 100 cases of megaloblastic anemia, moderate anemia was the most common category, observed in 48% of patients (Table 6).

DISCUSSION

Megaloblastic anemia is a common yet treatable cause of anemia.⁽¹⁾ It represents a heterogeneous group of disorders characterized by distinctive hematological abnormalities and overlapping clinical manifestations. The condition is defined by characteristic bone marrow changes involving erythroid, myeloid, and megakaryocytic precursors, leading to ineffective hematopoiesis and macrocytic anemia. It is frequently associated with leukopenia, thrombocytopenia, and various systemic manifestations. Deficiency of folate or cobalamin (vitamin B12) is the principal etiological factor in megaloblastic anemia. These deficiencies are linked to a broad spectrum of hematological and neuropsychiatric manifestations, many of which are potentially reversible with early diagnosis and timely treatment.^(3,6,7)

In the present study, the majority of participants belonged to the 11–30 years age group (49%). This finding is comparable to the observations of Sharma et al.⁽²⁾, who reported peak prevalence in the 16–30 year age group, and Shukla et al.⁽⁹⁾, who found most cases in the 20–40 year age range. In contrast, Agrawal et al.⁽⁸⁾ documented the highest incidence among older adults aged 46–60 years. These differences may be attributed to variations in demographic distribution, nutritional patterns, lifestyle factors, and the characteristics of the study populations.

A slight female preponderance (56%) was observed in the present study. However, several other studies have reported male predominance, including Singh RK et al.⁽¹⁾ (52% males), Khajuria A et al.⁽³⁾ (70% males), and Agrawal et al.⁽⁸⁾ (58.3% males). Such variations may reflect regional differences in dietary practices, healthcare-seeking behavior, socioeconomic conditions, and socio-cultural influences affecting gender-based nutritional status.

In the present study, the majority of patients with megaloblastic anemia belonged to the lower socioeconomic group (61%), followed by the middle (31%) and upper (8%) socioeconomic classes. These findings are in concordance with studies conducted by Singh et al.⁽¹⁾, Sharma et al.⁽²⁾, Khajuria et al.⁽³⁾, Yellinedi et al.⁽⁵⁾, Kaur et al.⁽⁶⁾ and Agrawal AR et al.⁽⁸⁾, all of which reported a higher prevalence of megaloblastic anemia among individuals from lower socioeconomic strata. The increased vulnerability in this group may be attributed to inadequate nutritional intake, limited dietary diversity, poor awareness regarding balanced nutrition, and restricted access to healthcare services.

In the present study, generalized weakness (92%) and pallor (88%) were the most common presenting complaints. These observations are consistent with multiple studies, including those by Singh et al.⁽¹⁾, Sharma et al.⁽²⁾, Khajuria et al.⁽³⁾, Yellinedi et al.⁽⁵⁾, Kaur et al.⁽⁶⁾, Agrawal et al.⁽⁸⁾, Shukla et al.⁽⁹⁾, Socha et al.⁽¹⁰⁾, and Hariz A et al⁽¹¹⁾, which similarly identified fatigue, pallor, and generalized weakness as the predominant clinical features. Neurological manifestations were less frequent but clinically significant, particularly in cases associated with vitamin B12 deficiency.^(7–9). Overall, anemia-related symptoms remain the primary mode of presentation in megaloblastic anemia, while systemic features such as hepatosplenomegaly and icterus are observed in a smaller proportion of patients.

In the present study, 68% of patients were vegetarians and 32% were non-vegetarians, suggesting a significant association between a vegetarian diet and megaloblastic anemia. Similar findings were reported by Aher et al.⁽⁷⁾, Agrawal et al.⁽⁸⁾and Shukla et al.⁽⁹⁾, where vegetarian dietary habits were identified as a common risk factor for vitamin B12 deficiency. In contrast, Kaur et al. observed a predominance of patients consuming a mixed diet without a significant association with vegetarianism, highlighting the influence of regional dietary practices and nutritional variations on disease prevalence.

Regarding the severity of anemia, moderate anemia (48%) was the most common presentation in the present study, followed by mild (29%) and severe anemia (23%). These findings are comparable to those reported by Singh et al.⁽¹⁾, Sharma et al.⁽²⁾, Khajuria et al.⁽³⁾, Yellinedi et al.⁽⁵⁾, and Kaur et al.⁽⁶⁾, Aher et al.⁽⁷⁾, Agrawal et al.⁽⁸⁾, Shukla et al.⁽⁹⁾ and Socha et al.⁽¹⁰⁾ and Hariz A et al.⁽¹¹⁾, where moderate anemia predominated and severe anemia constituted a smaller proportion of cases. This pattern may reflect earlier healthcare access and diagnosis before progression to severe anemia in most patients.

CONCLUSION

Megaloblastic anemia remains a common and treatable cause of anemia in tertiary care settings, particularly in developing regions, predominantly affecting young and middle-aged adults due to vitamin B12 and folate deficiencies. Patients typically present with weakness, pallor and fatigue with occasional neurological manifestations in B12 deficiency. Hematological findings such as macrocytic anemia with elevated MCV, hypersegmented neutrophils on peripheral smear, and occasional pancytopenia, along with hypercellular bone marrow showing megaloblastic erythropoiesis, aid in diagnosis. Early identification through clinical evaluation and laboratory assessment followed by timely vitamin supplementation, is essential to prevent complications and improve patient outcomes.

Conflict of Interest: None

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