Objective: To investigate the lifespan of erythrocytes in megaloblastic anemia (MA) patients. Methods: A prospective cohort study analysis. Clinical data from 42 MA patients who were newly diagnosed at the Department of Hematology, Lanzhou University Second Hospital from January 2021 to August 2021 were analyzed, as were control data from 24 healthy volunteers acquired during the same period. The carbon monoxide breath test was used to measure erythrocyte lifespan, and correlations between erythrocyte lifespan and laboratory test indexes before and after treatment were calculated. Statistical analysis included the t-test and Pearson correlation. Results: The mean erythrocyte lifespan in the 42 newly diagnosed MA patients was (49.05±41.60) d, which was significantly shorter than that in the healthy control group [(104.13±42.62) d; t=5.13,P=0.001]. In a vitamin B₁₂-deficient subset of MA patients the mean erythrocyte lifespan was (30.09±15.14) d, and in a folic acid-deficient subgroup it was (72.00±51.44) d, and the difference between these two MA subsets was significant (t=3.73, P=0.001). The mean erythrocyte lifespan after MA treatment was (101.28±33.02) d, which differed significantly from that before MA treatment (t=4.72, P=0.001). In MA patients erythrocyte lifespan was positively correlated with hemoglobin concentration (r=0.373), and negatively correlated with total bilirubin level (r=-0.425), indirect bilirubin level (r=-0.431), and lactate dehydrogenase level (r=-0.504) (all P<0.05). Conclusions: Erythrocyte lifespan was shortened in MA patients, and there was a significant difference between a vitamin B₁₂-deficient group and a folic acid-deficient group. After treatment the erythrocyte lifespan can return to normal. Erythrocyte lifespan is expected to become an informative index for the diagnosis and treatment of MA.
Humans ; Longevity ; Clinical Relevance ; Prospective Studies ; Erythrocytes ; Anemia, Megaloblastic ; Folic Acid ; Bilirubin ; Vitamins

Plasma homocysteine level and megaloblastic anemia status are two factors that can affect the quality of life of patients with multiple sclerosis (MS). We conducted this study to determine the effect of vitamin B12 and folic acid supplementation on serum homocysteine, megaloblastic anemia status and quality of life of patients with MS. A total of 50 patients with relapsing remitting multiple sclerosis (RRMS) included in this study which divided into 2 groups. The vitamin group received 5 mg folic acid tablet daily and 3 doses of vitamin B12 (1,000 mcg) injection and the other group received placebo and normal saline injection (same doses). The quality of life was measured by using Multiple Sclerosis Quality of Life-54 questionnaire (MSQOL-54). Fully automated fluorescence polarization immunoassay was used to measure serum homocysteine, vitamin B12 and folate. Complete blood count blood test was conducted to determine the anemia status. The mean homocysteine level reduced by 2.49 ± 0.39 µmol/L (p = 0.001), hemoglobin increased from 11.24 ± 1.54 to 13.12 ± 1.05 g/dL (p = 0.001), and mean corpuscular volume decreased from 95.50 ± 6.65 to 89.64 ± 4.24 in the vitamin group (p = 0.001). There was a significant improvement in the mental field of life quality in the placebo group (37.46 ± 19.01 to 50.98 ± 21.64; p = 0.001), whereas both physical and mental fields of quality of life were improved significantly in the vitamin group (40.38 ± 15.07 to 59.21 ± 12.32 and 29.58 ± 15.99 to 51.68 ± 18.22, respectively; p = 0.001). Serum homocysteine level decrease and anemia status improvement with vitamin B12 and folic acid supplementation reveal the potential role of these two vitamins in improving the life quality of MS patients. TRIAL REGISTRATION: Iranian Registry of Clinical Trials Identifier: IRCT2015100313678N7
Anemia* ; Anemia, Megaloblastic ; Blood Cell Count ; Erythrocyte Indices ; Fluorescence Polarization Immunoassay ; Folic Acid* ; Hematologic Tests ; Homocysteine* ; Humans ; Multiple Sclerosis* ; Multiple Sclerosis, Relapsing-Remitting ; Plasma ; Quality of Life* ; Vitamin B 12* ; Vitamins*

OBJECTIVETo study the clinical significance of serum protein expression level in patients with megaloblastic anemia(MA).

METHODSA total of 47 patients with MA were enrolled in this study between November 2013 and November 2015, and 50 healthy people in the same period were selected as controls. The levels of total protein (TP), albumin (Alb), ferritin (FER), transferrin (TRF) and soluble transferrin receptor (sTfR) were compared between 2 groups, and the serum protein expression levels in different types of MA, varous anemia degrees of MA were analyzed.

RESULTSThe leves of TP, Alb and FER in MA patients were significantly lower than those in control group, the levels of TRF and sTfR were statistically significantly higher than those in control group(P<0.05); the levels of TP, Alb and FER in the patients with mild anemia were significantly higher than those in the patients with moderate and severe anemia, the levels of TRF and sTfR were statistically significantly lower(P<0.05), while the levels of TP, Alb and FER in patients with moderate anemia were significantly higher than those in the patients with severe anemia, the levels of TRF and sTfR were significantly lower(P<0.05). Compared with levels before treatment, the levels of TP, Alb and FER significantly increased after treatment, while the TRF and sTfR levels significantly decreased (P<0.05).

CONCLUSIONSerum levels of TP, Alb, FER, TRF and sTfR can provide a basis for the diagnosis of MA, and contribute to predict the disease to some extent.

Anemia, Megaloblastic ; Ferritins ; Humans ; Receptors, Transferrin ; Transferrin

OBJECTIVETo investigate the clinical significance of bone marrow morphological differences in the differential diagnosis of megaloblastic anemia (MM) and refractory anemia (R4).

METHODSA total of 60 anemia patients selected from our hospital between April 2004 and April 2015 were divided into MA group (30 cases) and RA group (30 cases) in accordance with their clinical diagnosis. Clinical manifestations, results of bone marrow morphology test, blood examination, peripheral blood smear, erythroid megaloblastic variability rate and nucleated red blood cell level in the 2 groups were compared and analyzed.

RESULTSIncidence of fever, hemorrhage, digestive reaction, splenomegaly and fatigue as well as hemoglobin level, platelets and white blood cell counts in patients of MA group were similar to those of RA group, there was no statistically significant difference between 2 groups (P>0.05). The percentages of dysplastic hematopoiesis in erythroid cells, granulocytic cells, magakaryoajtic cells, the PAS-positive rate and red blood cell distribution in the MA patients were obviously lower than those in the RA patients, while the erythroid megaloblastic variability rate (90%) in MA group was obviously higher than that in RA patients (10%) and with statistically significant difference (P<0.05). The percentage of immature red blood cells was similar between MA group (53.33%) and RA group (60.00%), without significant difference (P>0.05).

CONCLUSIONMost of clinical manifestations and peripheral blood smear results are consistent in MA patients and RA patients, bone marrow morphology detection in RA group should be focused on lymphocytoid micromegakaryocytes, while the erythroid megaloblastic cell body is the focus in MA group, PAS can be used as a diagnostic criteria.

Anemia, Megaloblastic ; diagnosis ; Anemia, Refractory ; diagnosis ; Bone Marrow ; pathology ; Diagnosis, Differential ; Erythrocyte Count ; Humans ; Leukocyte Count ; Megakaryocytes ; cytology

OBJECTIVEThis study was to investigate the influence of morbidly hematopoietic characteristics on the prognosis of patients with myelodysplastic syndrome (MDS).

METHODSA total of 69 cases of MDS were analyzed retrospectively on ralatienship between sex, age, MDS types, WBC count, hemoglobin (Hb) level, platelet (Plt) count at diagnosis, morbidly cytologic features of bone marrow and survival time of MDS patients.

RESULTSThe median survival time of 69 cases of MDS was 29.90 months. The patients of different sexes and Plt level at diagnosis did not display statistically significant difference in median survival time (P > 0.05); the patients with different ages, WBC count and Hb level showed statistically significant difference in median survival time (P < 0.05); the median survival time of patients with different MDS types was significant different (P < 0.01); the MDS patients with myeloid lineage containing nuclear plasma development imbalance, micronuclei, abnormal mitotic figures, with erythroid lineage containing megaloblastic degeneration, cell size disparity, nuclcar budding and muclear fragmentation, and with megakaryocyte lineage containing micromegaryocytes, excessive muclear leaves, displayed significant difference in median survival time (P < 0.05). The MDS patients with ALIP positive, fibrosis in bone marrow blopsy showed significant difference in median survival time.

CONCLUSIONThe age, MDS types, Hb level and WBC count at diagnosis are indicators influencing the prognosis. The unbalanced development of muclear plasma, micronuclei, abnormal mitotic figures in myeloid morbid hematopoiesis, the megaloblastic degeneration, cell size disperity, muclear budding, nuclear fragmentation in erythroid morbid hematopoiesis, the micro-megakaryocytes, excessive nuclear leaves in megakaryocytic morbid hematopoiesis, and existance of ALIP posstive and fibrosis in bone marrow biopsy indicate important values for evaluation of MDS prognosis.

Anemia, Megaloblastic ; Biopsy ; Bone Marrow ; Humans ; Leukocyte Count ; Megakaryocytes ; Myelodysplastic Syndromes ; Prognosis ; Retrospective Studies

OBJECTIVETo evaluate the value of mean corpuscular volume/RBC distribution width (MCV/RDW) combined with reticulocyte parameters in differential diagnosis of aplastic anemia (AA), myelodysplastic syndrome (MDS), megaloblastic anemia (MA) and hemolytic anemia (HA) in order to provide some laboratorial evidence for clinical doctors in first diagnosis of these diseases.

METHODSThe data of MCV/RDW and reticulocyte parameters of AA, MDS, MA and HA patients from January 1 of 2011 to August 31 of 2014 were retrospectively collected in West China Hospital of Sichuan University. And 158 healthy unrelated individuals with age-, sex-matched were collected as controls. The value of MCV/RDW and reticulocyte parameters in differentiating diagnosis of above mentioned 4 kinds of anemia diseases was assessed. ROC analysis was used to determine the cutoff value of MCV/RDW and the reticulocyte parameters were performed in differentiating diagnosis of AA and MDS.

RESULTSThe average values of MCV/RDW of 158 AA patients (79 acute AA patients and 79 chronic AA patients), 107 MDS patients, 13 MA patients and 81 HA patients increased in variable degrees as compared with the controls, and there was statistical difference between them, the MCV/RDW value of acute AA patients was obviously less than that of other patients. In the 4 kinds of anemia diseases, the reticulocyte absolute count in acute AA patients was the lowest, that of chronic AA, MA and MDS patients was higher, and that of HA patients was highest. The ratio of low fluorescent reticulocyte decreased, and the ratio of moderate and high fluorescent reticulocytes increased in the 4 kinds of anemia diseases, as compared to controls. The difference was statistically significant. The analysis of differential diagnosis of chronic AA and MDS showed that RDW-SD could differentiate the chronic AA from MDS. The area under the curve (AUC) of RDW-SD was 0.76 (P < 0.01). The cutoff value of RDW-SD was 22.75fl. The sensitivity and specificity of RDW-SD for differential of chronic AA and MDS was 49.5% and 98.7%, respectively.

CONCLUSIONMCV/RDW and reticulocyte parameters can be used as the laboratorial differential diagnostic indicators for AA, MDS, MA and HA diseases.

Anemia, Aplastic ; Anemia, Hemolytic ; Anemia, Megaloblastic ; China ; Diagnosis, Differential ; Erythrocyte Indices ; Humans ; Myelodysplastic Syndromes ; Reticulocyte Count ; Reticulocytes ; Retrospective Studies

This study was aimed to explore the change characteristics of cell differentiation antigen (CD) on bone marrow (BM) granulocytes in patients,with megaloblastic anemia (MA). In combination with BM cell morphology, hemogram, level of blood serum folic acid, level of Vit B(12), cell genetics and biological examination data, the BM granulocytes differentiation antigens in 13 patients with MA were detected by flow cyto metry and analyzed retrospectively, in order to summarize the variation characteristics of CD13, CD33 and CD15 expressed on myeloid cells in patient with MA, including forward scatter light (FSC) and side scatter light (SSC) signal intensity, then these findings were compared with that in normal healthy persons. The results showed that the expression rates of CD13, CD15 and CD33 on granulocytic in patients with MA and normal healthy persons were (44.53 ± 16)%, (96.16 ± 2.67)%, (80.81 ± 14.71)% and (62.33 ± 11.02)%, (99.53 ± 0.46)%, (70.00 ± 7.81)% respectively, in which the expression rate of CD13 and CD15 in patients with MA decreased (P < 0.01), while the expression rate of CD33 increased (P < 0.01). The mean fluorescence intensity (MFI) of CD13, CD15, CD33, SSC and FSC in MA patients and normal healthy persons were 3.39 ± 1.41, 14.29 ± 6.59, 1.95 ± 0.94, 478.78 ± 70.43, 633.46 ± 75.53 and 5.12 ± 1.15, 20.67 ± 5.13, 1.04 ± 0.17, 332.00 ± 38.16, 537.00 ± 16.70 respectively, in which the MFI of CD13 and CD15 on granulocytes in MA patients decreased (P < 0.01),while the MFI of FSC,SSC and CD33 increased (P < 0.01 and P < 0.05). It is concluded that not only the morphology of BM granulocytes in patents with MA shows dysmaturity, but the expressing feature of differentiation antigens on BM granulocytes in MA patients also displays dysmaturity.These findings will contribute to the clinical diagnosis of MA patients.
Adult ; Aged ; Anemia, Megaloblastic ; diagnosis ; immunology ; metabolism ; Antigens, CD ; metabolism ; Case-Control Studies ; Female ; Granulocytes ; metabolism ; Humans ; Male ; Middle Aged ; Retrospective Studies

Anemia is the most common hematologic finding in patients with advanced infections caused by human immunodeficiency virus (HIV) or advanced acquired immunodeficiency syndrome (AIDS). Among many etiologies of HIV-associated anemia, vitamin B12 deficiency plays an important role, mostly due to malabsorption or HIV enteropathy. We experienced a case of megaloblastic anemia caused by vitamin B12 deficiency in a male patient with an AIDS who had no structural gastrointestinal problem. He showed severe anemia, leukopenia, thrombocytopenia and suspicious neurologic manifestations such as aggravation of dementia and gait disturbance. With vitamin B12 and folate treatment, the patient's general condition and hematologic features were improved successfully.
Acquired Immunodeficiency Syndrome ; Anemia ; Anemia, Megaloblastic ; Dementia ; Folic Acid ; Gait ; HIV ; HIV Enteropathy ; Humans ; Leukopenia ; Male ; Neurologic Manifestations ; Thrombocytopenia ; Vitamin B 12 ; Vitamin B 12 Deficiency ; Vitamins

BACKGROUND: Macrocytic anemias are commonly seen in clinical practice, and precise etiologic diagnosis is essential for proper management. We evaluated the clinical utility of reticulocyte maturation parameters in macrocytic anemias to discriminate among myelodysplastic syndrome (MDS), megaloblastic anemia (MA), and non-megaloblastic macrocytic anemia associated with chronic liver disease (MA-CLD). METHODS: Using an automated reticulocyte counter, we retrospectively analyzed and compared reticulocyte maturation parameters including immature reticulocyte fraction (IRF), mean reticulocyte volume (MRV), mean sphered cell volume (MSCV) of normal control (N=34), and patients diagnosed with MDS (N=31), MA (N=52), and MA-CLD (N=196). RESULTS: Macrocytic anemias from MA, MDS and MA-CLD showed higher values of reticulocyte maturation parameters including IRF, MRV and MSCV than normal control (P<0.01). MDS showed higher values of reticulocyte maturation parameters including IRF, MRV and MSCV than MA-CLD (P<0.01). IRF and MRV were significantly lower in MA-CLD than in both MA and MDS (P<0.01). MSCV was significantly higher in MDS than in MA (P<0.01). CONCLUSIONS: This study indicates that the measurement of reticulocyte maturation parameters may be a useful tool in the differential diagnosis of macrocytic anemia. The presence of high values of IRF (> or = 0.39), MRV (> or = 129.5 fL), and MSCV (> or = 102.3 fL) makes the diagnosis of MA-CLD unlikely and underlying MDS should be considered.
Adult ; Anemia, Macrocytic/*diagnosis ; Anemia, Megaloblastic/*diagnosis ; Chronic Disease ; Diagnosis, Differential ; Female ; Humans ; Liver Diseases/*diagnosis ; Male ; Middle Aged ; Myelodysplastic Syndromes/*diagnosis ; Reticulocyte Count/*methods

No abstract available.
Anemia, Megaloblastic ; Anemia, Pernicious* ; Vitamin B 12