Saira Perwaiz Iqbal, Ghulam Nabi Kakepoto, Saleem Perwaiz Iqbal


Background: Folate and vitamin B12 deficiencies have been known to cause megaloblastic anaemia.
Since the deficiencies of these two vitamins are very common in Pakistani population, it would be
imperative to investigate their role in causing megaloblastic anaemia. The objective of this study was to
find out the contribution of folate and vitamin B12 deficiencies in causing megaloblastic anaemia in our
patient population. Methods: In this retrospective cohort study, clinical records of 220 patients (101
females and 119 males with an age range of 1–80 years) who presented themselves with macrocytic
anaemia at the Aga Khan University Hospital were collected. Data pertaining to complete blood count
and serum levels of folate and vitamin B12 were analysed. Results: The mean haemoglobin (Hb) level
was 6.8±0.2 gm/dl. Sixty-nine percent of the patients had severe anaemia (Hb<8 gm/dl). Mean±SEM
values of haemoglobin, serum folate and serum B12 were not significantly different between males and
females (Hb 6.4±0.3 gm/dl vs 6.3±0.3 gm/dl; folate 6.9±0.8 ηg/ml vs 7.8±1 ηg/ml; B12 259±65 ρg/ml
vs 225±45 ρg/ml, respectively). Linear regression analysis showed that serum folate was inversely
related with the mean corpuscular volume (MCV, p=0.04). Spearman’s correlation analysis indicated
an inverse mild association between MCV and serum folate (correlation coefficient= -0.18). Folate
deficiency was 43.4%, while vitamin B12 deficiency was 78.5% in these patients. Seventy-one percent
of folate-deficient patients had vitamin B12 deficiency as well, while 26.1% of patients with B12
deficiency had a co-occurrence of folate deficiency. Conclusion: Vitamin B12 deficiency appears to be
the major factor leading to megaloblastic anaemia in our study population. Inadequate dietary intake,
over-cooking of our food and poor absorption might be contributing to high prevalence of vitamin B12
deficiency in this population.
Keywords: Cobalamin deficiency, folate deficiency, macrocytic anaemia, megaloblastic anaemia,
nutritional anaemia, vitamin B12 deficiency, Pakistan

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Gibson RS. Principles of Nutritional Assessment. Oxford:

Oxford University Press; 1990.p. 461–86.

Kakepoto GN, Iqbal MP, Iqbal SP. Megaloblastic anaemia is

a hospital-based population. Med Sci Res 2000;28:45–7.

Hashim H, Tahir F. Frequency of vitamin B12 and folic acid

deficiencies among patients of megaloblastic anaemia. Ann

Pak Inst Med Sci 2006;2(3):192–4.

Mannan M, Anwar M, Saleem M, Wiqar A, Ahmad M. A

study of serum vitamin B12 and folate levels in patients of

megaloblastic anaemia in Northern Pakistan. J Pak Med

Assoc 1995;45:187–8.

Khanduri U, Sharma A. Megaloblastic anameia: prevalence

and causative factors. Natl Med J India 2007;20(4):172–5.

Sarode R, Garewal G, Marwaha N, Marwaha RK, Varma S,

Ghosh K et al. Pancytopenia in nutritional megaloblastic

anaemia: A study from North-West India. Trop Georgr Med


Erslev AJ, Gabuzda TG. Pathophysiology of Blood. 3rd ed.

Philadelphia: WB Saunders Company; 1985.p. 71–2.

Iqbal MP, Ishaq M, Kazmi KA, Yousuf FA, Mehboobali N,

Ali SA, et al. Role of vitamins B6, B12 and folic acid on

hyperhomocysteinemia in a Pakistani population of patients

with acute myocardial infarction. Nut Metab Cardiovasc Dis


Yakub M, Iqbal MP, Mehboobali N, Haider G, Parveen S,

Kakepoto GN, et al. High prevalence of folic acid, vitamin

B6 and vitamin B12 deficiencies is a predictor of

hyperhomocysteinemia in a Pakistani urban population. In:

Abstract Book: 21st International Medical Sciences Student

Congress. Istanbul University. Istanbul. 2008;75. (Abstract).

Naeem MA, Uttra GM. Etiology of incidence of

megaloblastic anaemia in district Gilgit. Pak J Pathol


Chan CW, Liu SY, Kho CS, Lau KH, Liang YS, Chu WR, et

al. Diagnostic clues to megaloblastic anaemia without

macrocytosis. Int J Lab Hematol 2007;29(3):163–71.

Lindenbaum J, Healton EB, Savage DG, Brust JC, Garrett

TJ, Podell ER et al. Neuropsychiatric disorders caused by

cobalamin deficiency in the absence of anaemia or

macrocytosis. N Engl J Med 1988;318(26):1720–8.

Robert C, Brown DL. Vitamin B12 deficiency. Am Fam

Physician 2003;67:979–86.


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