Megaloblastic anemia and gastrointestinal manifestations in Lima. The tip of the iceberg

The records of the last three years from the Hematology service are reviewed and twenty patients (6.23%) fulfilling the inclusion criteria were chosen out of a total of 316.pallor and malaise 100%, change in bowel movements 75%, nausea, vomiting and hemorrhage 40%, jaundice 25%, nausea aroused by food 20%, infection 10%. Severe hyporegenerative anemia 100%, thrombocytopenia 75%, pancytopenia 60%. We found as associated conditions: gynecological and obstetric history 25%, enteric and peritoneal tuberculosis 15%, and without an apparent cause (primary) 40%. Levels of vitamin B12 and folic acid were measured in eleven patients and the finding were: B12 deficiency in six (54.5%), folic acid deficiency in three (27.2%) and deficiency of both in two (18.1%). With the exception of one patient who died from sepsis, all the other patients had a favorable outcome with vitamin treatment. We found folic acid deficiency associated with ferropenia mainly in those patients with obstetric history; the combined deficit in those patients with an associated pathological process, and B12 deficiency in the group without any apparent cause. From the available national information and our observations we can conclude that we are facing an outbreak of megaloblastic anemia that frequently goes on with gastrointestinal manifestations and for which the cause has not been elucidated.