| Objective:To study the clinical and laboratory examination characteristics of patients with megaloblastic anemia(MA)in order to explore the etiology of hospitalized MA patients in our hospital,and to analyze the clinical characteristics of elderly MA patients.Methods:Data of 54 MA patients admitted to the First Affiliated Hospital of Fujian Medical University from January 2013 to July 2020 were retrospectively analyzed.General conditions including age,gender,dietary habits,past history of gastrointestinal diseases and history of gastrointestinal surgery of the patients were recorded,and blood routine,biochemical,folic acid and vitamin B12 concentrations were also detected.According to age,it is divided into elderly group(age ≥ 60 years old)and non-elderly group(age <60).Statistical methods including t-test,u-test,chi-square test and other statistical methods were used to compare the indicators of gender,age,average hemoglobin(Hb),red blood cell volume(MCV),lactate dehydrogenase(LDH),total bilirubin(TBIL)and indirect bilirubin(IBIL),serum albumin(propagated)in the two groups.Risk factors of severe anemia were analyzed by binary logistics regression.Results:A total of 54 patients with MA who were hospitalized in the First Affiliated Hospital of Fujian Medical University were included in this study.A detailed medical history was performed,including living habits,eating habits,past history,etc.,and statistical analysis was performed after a comprehensive physical examination.1.In addition to the general symptoms related to anemia,the symptoms of cardiovascular system(22.2%),digestive system(14.8%)and nervous system(9.3%)were more prominent in MA patients.Some patients showed skin and mucosal bleeding(9.3%)and hemolysis(11.1%),and a few patients showed neuropsychiatric abnormalities(5.6%).2.Patients with MA are often complicated with other system-based diseases and survive with diseases.In this study,the most prominent disease of MA was due to the past history of gastrectomy(40.7%),followed by alcoholism(16.7%),chronic atrophic gastritis(9.3%),and long-term partial eating(7.4%).In this study,22 MA patients developed megaloblastic anemia 5-20 years after gastric surgery,with an average onset of 8.0(7.0-10.5)years after surgery.3.The majority of inpatients with MA were deficient in Vit B12 and less in folic acid.4.According to age,the patients were divided into elderly group and non-elderly group.There was no statistical significance in gender between the two groups.(P=0.151).The comparison between the two groups showed statistical significance in previous gastrectomy,other systemic diseases,severe anemia(Hb < 60g/L),incidence of triple reduction,incidence of LDH > 1000U/L,Vit B12 level and ALB level(P=0.043,0.030,0.042,0.039,0.017,0.021,0.048).According to the blood routine situation of the three lines,the patients were divided into the first line reduction,the second line reduction,and the third line reduction.The non-elderly group mostly showed the second line reduction,while the old group mostly showed the third line reduction.5.According to Hb level,the patients were divided into severe anemia group(Hb< 60 g/L)and non-severe anemia group(Hb≥60 g/L).The comparison between the two groups showed statistical significance in MCV,TBIL,IBIL,LDH and pancytopenia(P = 0.018,0.006,0.018,0.001,0.036).Anemia and severity were associated with higher MCV,higher bilirubin level,higher LDH level and pancytopenia.LDH and TBIL were risk factors for severe anemia in MA patients.Conclusion:The inpatient MA was mainly due to vitamin B 12 deficiency,and the most prominent disease was due to the history of gastric surgery.Older MA patients have more underlying diseases and are sicker.LDH and TBIL are risk factors for severe anemia in patients with MA. |
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