Clinical Features and Outcomes of Patients with Non-Iron
Nutritional Deficiency Anemia in an In-Patient Setting
at Siriraj Hospital: A 10-Year Retrospective Study
Wasithep Limvorapitak MD*,
Chirayu U Auewarakul MD, PhD**
Affiliation :
* Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
** Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Anemia is a major public health issue despite preventive interventions. Data on non-iron nutritional deficiency
anemia in hospitalized patients are limited.
Objective : This study explored the incidence, clinical features, and outcomes of hospitalized patients diagnosed with
non-iron nutritional deficiency anemia at a major teaching hospital in Thailand.
Material and Method: Medical records of in-patient departments dated between January 2001 and June 2011 were
retrospectively reviewed.
Results : One hundred and two cases were identified, including 40 patients with vitamin B12 deficiency, 46 with folate
deficiency, and 16 with other nutritional deficiency anemias; corresponding incidence rates were 0.4, 0.6, and 0.2 cases
per 100,000 per year, respectively. Patients with vitamin B12 deficiency were mostly female, while patients with folate
deficiency were preponderantly male. Glossitis and pancytopenia were common characteristics of vitamin B12 deficiency
cases, whereas alcohol abuse and cirrhosis were more frequent in folate deficiency cases, as expected. Serum ferritin levels
were relatively high across all categories. A significant proportion of anemia cases across all subgroups presented
concomitantly with anorexia or poor food intake, which indicates underlying nutritional problems in these patients. Survival
of patients with folate and other types of nutritional deficiency anemia was lower than for patients with vitamin B12 deficiency
anemia (hazard ratio [HR] and p-values were 2.65, 0.001 and 2.35, 0.023, respectively). Hemoglobin normalization in
patients with vitamin B12 deficiency anemia could be achieved by intramuscular injection and oral vitamin B12 treatment
in 55.56% and 33.33% (p = 0.248), with a median response time of 9 and 86 weeks (p = 0.151), respectively.
Conclusion : Non-iron nutritional deficiency anemia was not common in hospitalized patients in this study. Vitamin B12
injections resulted in faster responses, but with similar efficacy compared with oral treatments. Survival of patients with
vitamin B12 deficiency anemia was significantly better than that of those with folate or other types of nutritional anemia.
Keywords : Nutritional deficiency anemia, Megaloblastic anemia, B12 deficiency, Clinical outcome, Thailand
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