The characteristics of megaloblastic anemia associated with thalassemia.

Combined megaloblastic anemia with thalassemia is easily masked because of the loss of macrocytosis. We performed a retrospective study to compare the major parameters in 4 groups of subjects in order to show the characteristics of patients with megaloblastic anemia and thalassemia. Group A comprised 9 patients with megaloblastic anemia and tha-lassemia, group B comprised 10 patients with uncomplicated megaloblastic anemia. Group C comprised 12 uncomplicated thalassemia trait and group D was formed of 11 healthy controls. The mean corpuscolar volume (MCV) in group A patients was not significantly different from that in normal subjects, but was significantly lower and higher than in those with pure megaloblastic anemia and pure thalassemia, respectively. Other parameters were not different between patients with uncomplicated megaloblastic anemia and megaloblastic anemia complicating thalassemia. Most of the manifestations in megaloblastic anemia complicating thalassemia were similar to those of uncomplicated megaloblastic anemia but not to uncomplicated thalassemia. Combined megaloblastic anemia with thalassemia is still an easily diagnosed disease. Uncomplicated megaloblastic anemia is easily diagnosed by an experienced hematologist when a high mean corpuscular volume (MCV) is present. 1 However, if this condition is associated with another disease such as thalassemia, the high MCV can be masked. 2-4 In our country, the prevalence of thalassemia is about 4-8%, 5-7 thus, the chance of megaloblastic anemia associated with thalassemia is possible and can be missed. As there are few data on complete blood counts (CBC) in this situation, the present study tried to find out their characteristics. Four groups entered the study. Nine patients were found to have a diagnosis of megaloblastic anemia with thalassemia (group A) in our hospital between 1960 and 2001. The major criteria for the diagnosis of megaloblastic anemia were typical bone marrow changes and low serum vitamin level (either serum vitamin B12 or folate). The diagnosis of α or β thalassemia minor was made by hemoglobin H staining and hemoglobin elec-trophoresis. The patients' mean age was 51.7±20.1 years (range 23-89 years). We also randomly selected age-matched subjects with complete enough data to rule out any complicated conditions to fit the criteria of the other 3 groups. Group B contained 10 patients with uncomplicated megaloblastic anemia. Group C contained 12 patients with uncomplicated thalassemia minor without any previous transfusion. Group D contained 11 healthy controls without any history of anemia and with normal CBC and vitamin levels. Mann-Whitney's U test was used to test the …