NUTRITIONAL MACROCYTIC ANAEMIA

First described by Wills(1930) found in Indian women; the disorder represents dietary inadequacy of folic acid and/or vitamin B12. The relative proportion of folic acid and vitamin B12 deficiency varies from one patient to another, and from one place to another depending mainly on the dietary habits of the patient concerned. It is particularly common in the poor people of tropical and sub-tropical countries. Apart from poverty, religious tenets and wrong dietary habits contribute to dietary inadequacy. Megaloblastic anaemias in infancy and pregnancy are variants of this disorder. Increased demands of the stressful periods, unmasking a latent deficiency. Adequate amount of intrinsic factor is present. In an average case, there is no significant evidence of malabsorption of vitamin B12 and folic acid, though, diarrhoea, steatorrhoea, and a flat glucose tolerance curve may be present. When prolonged deficiency has led to severe depletion, a secondary factor of intestinal malabsorption may be superimposed due to dystrophic changes of intestinal mucous membrane. The disorder is uncommon in temperate climates where occasional cases are seen in infancy, pregnancy and in association with dietary inadequacy incidental to vegetarianism.