STUDY OF INCIDENCE AND TREATMENT OUTCOMES OF MEGALOBLASTIC ANAEMIA PRESENTING AS PYREXIAL DISORDER.
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Keywords
Megaloblastic anemia, Pyrexial disorder, Vitamin B12 deficiency.
Abstract
: Megaloblastic anemia (MA) is an underrecognized cause of Pyrexial disorder ,often triggering extensive investigations for infections or malignancies. Prospective data on its clinical-therapeutic profile remain scarce.
Objectives: 1) Characterize clinical/hematological features of MA presenting as Pyrexial disorder and to evaluate response to vitamin B12.
Methods: A 12-month prospective cohort study (2024–2025) was conducted at Lata Mangeshkar Hospital, attached to the N.K.P.Salve Institute of Medical Sciences & Research Centre, Nagpur.Adults (≥18 years) with Pyrexial disorder (fever >101°F for ≥3 days) and MA (Hb <11g/dL /<12g/dL M + MCV>110fL/peripheral smear abnormalities/B 12 <200pg/mL after excluding infections/malignancies were enrolled . Standardized B<sub>12</sub> therapy was administered. Outcomes included fever resolution time, hematological .recovery, and symptom response.
Results: 56 adults with megaloblastic anaemia and Pyrexial disorder, exhibiting a male predominance (57.1%) and mean age of 41.3 ± 14.9 years. Patients presented with prolonged fever (mean 6.8±2.3 days), severe macrocytic anemia (Hb 7.2±1.4 g/dL; MCV 116.4±8.7 fL), and inflammation (92.9% elevated ESR; 89.3% elevated CRP). Fever resolved rapidly after therapy initiation (median 36 hours), with 87.5% afebrile within 48 hours. Hemoglobin significantly increased by Day 7 (8.9±1.3 g/dL, p<0.001) and normalized in 85.7% by Day 28.
Conclusions: MA is a reversible cause of Pyrexial disorder characterized by triad of high-grade fever, macrocytic anemia, and systemic inflammation. Rapid defervescence within 48 hours of B12 therapy serves as a diagnostic-therapeutic indicator. Early empiric hematinic intervention in Pyrexial disorder patients with macrocytosis prevents unnecessary antimicrobial use, reduces diagnostic costs, and mitigates neurological sequelae.
References
2. Siddiqui B, Rabindranath D, Faridi SH, Khan AA, Haiyat S, Eswaran R. Megaloblastic anemia: A common but often neglected cause of pyrexial disorder. J Transl Int Med. 2015 Apr-Jun;3(2):64-67. doi: 10.1515/jtim-2015-0005. Epub 2015 Jun 30.
3. Manuel K, Padhi S, G’boy Varghese R. Pyrexia in a patient with megaloblastic anemia: A case report and literature review. Iran J Med Sci. 2013;38( 2 Suppl):198–201.
4. Hoffbrand HV. Megaloblastic anemia and miscellaneous deficiency anemias. In: Worrell DA, Cox TM, Firth JD, Ben Jr, editor. Oxford Textbook of clinical Medicine. 4. Vol. 3. Oxford: Oxford University Press 2003: 659-75.
5. McKee LC Jr. Fever in megaloblastic anemia. South Med J. 1979 Nov;72(11):1423-4, 1428.
6. Behera V, Kumar R, Agrawal C, Kapoor R, Kaur N, Nair V. Clinico-laboratory Profile and Outcomes of Megaloblastic Anemia presenting as Severe Pyrexial Illness mimicking Tropical Infection. J Assoc Physicians India. 2023 May;71(5):11-12. doi: 10.5005/japi-11001-0222.
7. Negi RC, Kumar J, Kumar V, Singh K, Bharti V, Gupta D, Kashyap R, Raina S. Vitamin B12 deficiency presenting as pyrexia. J Assoc Physicians India. 2011 Jun;59:379-80.
8. Jaina D, Jain P, Aggarwal HK, Kaverappa V, Kumar A. Megaloblastic Anaemia Presenting as Pyrexia: An Interesting Case Report. J Hematol. 2012;1(4-5):102-4.
9. Green R, Datta Mitra A. Megaloblastic Anemias: Nutritional and Other Causes. Med Clin North Am. 2017 Mar;101(2):297-317
10. Stabler SP. Vitamin B12 Deficiency. N Engl J Med. 2013;368(2):149-60.
11. Andrès E, et al. Hematological Manifestations of B12 Deficiency. Expert Rev Hematol. 2022;15(7):671-685.
12. Reynolds EH. Neurological Consequences of Folate Deficiency. Handb Clin Neurol. 2014;120:927-43.
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Dr. Arvind Agrawal
Assistant professor , Department of General Medicine, NKP Salve Institute of Medical Sciences Nagpur,
Dr Nalini Humney
Professor, Department of General Medicine, NKP Salve Institute of Medical Sciences Nagpur.
Dr. Shilpa Kuthe
Associate Professor, Department of General Medicine, NKP Salve Institute of Medical Sciences Nagpur.