Mobina Ahsan Dodhy, Nusrat Bokhari, Abbas Hayat.
Chronic diarrhea, a presenting feature of megaloblastic anemia.
Ann Pak Inst Med Sci Jan ;1(4):201-5.

Background: Megaloblastic Anaemia is quite a common disease in our setup. A majority of patients suffering from this illness alone or with concomitant Iron deficiency anemia present with gastrointestinal manifestations particularly diarrhea. Objective: To determine the frequency of association of chronic diarrhoea to megaloblastic anaemia based only on clinical history and bone marrow findings. To further evaluate the said association in two groups of patient: one group with Megaloblastic anaemia alone and the other with concomitant iron deficiency anaemia. Study Design and Duration of Study: It was a descriptive study conducted at the Department of Haematology, Rawalpindi General Hospital, Rawalpindi from April 1999 to April 2004. Material and Methods: All the patients presenting with Megaloblastic Anaemia or Megaloblastic Anaemia with concomitant iron deficiency anaemia (Mixed deficiency anaemia) to the Haematology department were reviewed in the study. The data of 482 patients was reviewed. They were divided into two groups, patients with Megaloblastic anaemia alone (Group A) and those with concomitant iron deficiency anaemia (Group B). The two groups were evaluated separately. History, clinical findings, peripheral blood picture and bone marrow findings were noted. Results: Of all the patients with Megaloblastic anemia (n=482) either Megaloblastic anaemia alone or with concomitant iron deficiency, 48.13% (n=232) had chronic diarrhoea as the presenting feature. In Group A diarrhoea was the presenting feature in 55.4% (n=152) patients, while in Group B diarrhoea was present in 38.46% (n=80) patients. Most of these patients had been treated for diarrhea by general practitioners. Other symptoms were pallor, generalized weakness, vomiting, fever, jaundice, bleeding Conclusion: There is a high frequency of presentation of chronic diarrhoea in patients with Megaloblastic anaemia thus causing considerable morbidity as a diagnosis is delayed and the patients are mismanaged due to a lack of awareness regarding the diagnosis and management of this considerable common disease.

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