• 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 beimperative to investigate their role in causing megaloblastic anaemia. The objective of this study was tofind out the contribution of folate and vitamin B12 deficiencies in causing megaloblastic anaemia in ourpatient population. Methods: In this retrospective cohort study, clinical records of 220 patients (101females and 119 males with an age range of 1–80 years) who presented themselves with macrocyticanaemia at the Aga Khan University Hospital were collected. Data pertaining to complete blood countand serum levels of folate and vitamin B12 were analysed. Results: The mean haemoglobin (Hb) levelwas 6.8±0.2 gm/dl. Sixty-nine percent of the patients had severe anaemia (Hb<8 gm/dl). Mean±SEMvalues of haemoglobin, serum folate and serum B12 were not significantly different between males andfemales (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/mlvs 225±45 ρg/ml, respectively). Linear regression analysis showed that serum folate was inverselyrelated with the mean corpuscular volume (MCV, p=0.04). Spearman’s correlation analysis indicatedan inverse mild association between MCV and serum folate (correlation coefficient= -0.18). Folatedeficiency was 43.4%, while vitamin B12 deficiency was 78.5% in these patients. Seventy-one percentof folate-deficient patients had vitamin B12 deficiency as well, while 26.1% of patients with B12deficiency had a co-occurrence of folate deficiency. Conclusion: Vitamin B12 deficiency appears to bethe 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 B12deficiency in this population.Keywords: Cobalamin deficiency, folate deficiency, macrocytic anaemia, megaloblastic anaemia,nutritional anaemia, vitamin B12 deficiency, Pakistan


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