Folate and cobalamin deficiency in megaloblastic anemia in children
Chandra, J.; Jain, V.; Narayan, S.; Sharma, S.; Singh, V.; Kapoor, A.K.; Batra, S.
Indian Pediatrics 39(5): 453-457
2002
ISSN/ISBN: 0019-6061 PMID: 12037276 Document Number: 550113
The relative prevalence of cobalamin and folate deficiency in hospitalized children with megaloblastic anaemia was investigated and the serum cobalamin and folate levels of exclusively breastfed children were correlated with the serum levels of their mothers. From May 1998 to January 1999, a total of 68 cases were initially enrolled in the Divisions of Pediatric Hematology and Biochemistry, Kalawati Saran Children Hospital and Department of Pathology, Lady Hardinge Medical College, New Delhi, India. Fifty-one patients aged 6-132 months (median: 18 months) were included in the study. However, the serum sample in one case was misplaced and folate and cobalamin levels could not be ascertained. Results showed that breastfed children (Group A; n=35) were significantly younger compared to other children (Group B; n=15) (P<0.001). Clinical features and haematological parameters were similar for both groups except for median platelet count which was significantly lower in Group B (P<0.05). Median serum folate and cobalamin levels in both A and B were similar (P>0.05). Folate deficiency was observed in 25 cases (50%) and cobalamin deficiency was seen in 31 (62%). Fifteen cases (30%) had both cobalamin and folate deficiency. Ten cases (20%) had pure folate deficiency and 16 cases (32%) had pure cobalamin deficiency. Serum levels of folate and cobalamin were within normal range in nine cases. Median cobalamin level of 15 mothers was 43.23 pg/ml, with 11 (73.33%) with levels below 200 pg/ml. Median folate level in mothers were 5.24 ng/ml with 6 (40%) mothers having folate levels below 5 ng/ml. Maternal cobalamin level had a significant positive correlation with the cobalamin level in children (r=0.585, P=0.022). It is concluded that folate and cobalamin deficiencies contribute significantly as an aetiological factor for megaloblastic anaemia in children. Cobalamin deficiency appears to be more common in young exclusively breastfed children and the low serum cobalamin levels probably reflect maternal cobalamin status.