Retrospective evaluation of nutritional anemia in pediatric patients

Objective: Iron deficiency, vitamin B12 deficiency and folic acid deficiency are the main causes of nutritional anemia. This study was carried out to determine the frequency and distribution of iron deficiency, B12 deficiency, folic acid deficiency and combined deficiencies (iron deficiency + B12 deficiency) according to age groups in patients diagnosed with nutritional anemia, and to examine the relationship between combined nutritional anemia and erythrocyte indices. Materials and Methods: The files of patients aged 1 month-18 years, who applied to the Pediatric Hematology Policlinic of Manisa Celal Bayar University Faculty of Medicine between January 2015 and December 2020 and were followed up with nutritional anemia, were retrospectively analyzed. Patients whose hemogram parameters, iron, total iron binding capacity, ferritin, B12 and folic acid levels were studied were included in the study. Results: A total of 407 patients, 252 (61,9%) female and 155 (38,1%) male, were included in the study. The mean age of the patients was 8.82 ± 6.15 years. Iron deficiency anemia was detected in 192 (47,2%) individuals, B12 deficiency anemia in 23 (5,7%) individuals, and combined (iron+B12) nutritional anemia in 185 (45,4%) individuals. While nutritional anemia was most common in the 12-18 age group (43,2%), it was second most common in the 0-2 age group (21,9%). The most common symptom at admission was fatigue in 115 patients (28,2%), followed by anorexia in 63 (23,7%) patients. Statistically significant difference between patients with isolated iron deficiency anemia and patients with combined nutritional anemia, age, WBC, RBC, Hb, Htc, MCH, MCHC, RDW, PLT, PLT/MCV, PLT/MCH iron binding capacity, ferritin and folic acid levels not detected. However, MCV, iron and TS were found to be lower in the group with iron deficiency anemia, while B12 levels were found to be lower in the group with combined nutritional anemia (p<0.05). The mean MCV value was found to be 72.18 fl in the group with combined nutritional anemia. In our study, we found macrocytosis in only one (4,3%) of 23 patients admitted with isolated B12 deficiency anemia. In the isolated B12 deficiency anemia group, microcytosis was detected in 8 patients (34,7%), while normocytosis was detected in 14 patients (60,9%). Discussion and Conclusion: The MCV value alone may not always guide the diagnosis of B12 deficiency anemia and should not be used alone in the diagnosis of megaloblastic anemia. The presence of macrocytosis in only one of 23 patients with isolated B12 deficiency anemia in our study is an indication of this. Iron deficiency may mask the macrocytosis seen in B12 deficiency anemia. In addition, if iron deficiency is accompanied by vitamin B12 deficiency, a normal or low MCV may cause a misdiagnosis. In our study, we found macrocytosis in only one (4,3%) of 23 patients admitted with isolated B12 deficiency anemia. In the isolated B12 deficiency anemia group, microcytosis was detected in 8 patients (34,7%), while normocytosis was detected in 14 patients (60,9%). As seen in our study, combined nutritional anemia is as common as iron deficiency anemia and presents as microcytic anemia. Since B12 deficiency can cause permanent neurological damage, B12 levels should be checked in addition to iron parameters in patients presenting with microcytic anemia. Key words: iron deficiency anemia, B12 deficiency anemia, combined nutritional anemia, mean erythrocyte volume