Prothrombotic Factors in Nutritional Megaloblastic Anemia in Children and Response to Therapy

Abstract Objective: The objective of the study was to estimate the serum prothrombotic factors (homocysteine, D-dimer, and fibrinogen levels) in children with nutritional megaloblastic anemia (MA) and to see the response to therapeutic intervention. Methods: A prospective study was conducted at the hemato-oncology division of the department of pediatrics of a tertiary care hospital, wherein, 40 children with MA and 40 healthy controls aged 6 months–12 years were recruited. Megaloblastic anemic cases were given oral tablet Vitamin B12 1000 μg daily for 2 weeks followed by 1000 ugm weekly for 6 weeks and tablet folic acid 5 mg daily for 8 weeks. Pre- and posttreatment serum levels of prothrombotic factors (serum homocysteine, fibrinogen, and D-dimer) were assessed. Results: Vitamin B12 deficiency (<200 pg/ml) was found in 29 cases, isolated folate deficiency (<2 ng ml) was noted in 2, and 2 cases had combined Vitamin B12 and folate deficiency. The mean baseline levels of homocysteine (36.50 ± 13.88 umol/L versus [10.57 ± 2.67 umol/L] [ P = 0.000] and fibrinogen [415.0 ± 110.96 mg/dL vs. 356.50 ± 124.25 mg/dL; P 0.029]) were significantly higher in cases than controls. However, a significant posttreatment fall was noticed in both homocysteine (15.75 ± 8.17 umol/L vs. 36.50 ± 13.88 umol/L; P = 0.000) and fibrinogen levels (415.0 ± 110.96 mg/dL vs. 323 ± 137.80 mg/dL; P = 0.002). Similarly, Baseline D-dimer levels were significantly higher in cases compared to controls (500 [median interquartile range (IQR): 400–3200] ng/mL vs. 95.0 [median IQR: 60–110] ng/mL; P = 0.000). Significant posttreatment fall was also noticed (475 [median IQR: 5021075] ng/mL; P = 0.002). Conclusions: Biochemical prothrombotic state may exist in nutritional MA and treatment with vitamins has a significant impact on reduction of the levels of these prothrombotic factors.