Megaloblastic anemia as a complication of thalassemia is rare. The first case, reported in 1949 by Crosby and Sacks,1 was of the coincidental finding of addisonian pernicious anemia occurring in an Italian with Mediterranean anemia. Since then 15 additional cases of folic acid or vitamin-B12-deficient megaloblastic anemia complicating thalassemia have been reported.2-6 Of these 6 cases have been associated with a nutritional deficiency of one or both of these vitamins.5 One case was associated with pregnancy.6 Of the remaining 8 cases 6 had no additional cause for folic acid deficiency other than the increased need caused by the increased erythropoiesis that accompanies thalassemia. In the other 2 cases there was a suggestion of an absorption defect for folic acid in addition to their increased requirement for the vitamin.3,4 Most of these cases were adults, but 2 of them occurred in children of 11½
ROBINSON MG, WATSON RJ. Megaloblastic Anemia Complicating Thalassemia Major. Am J Dis Child. 1963;105(3):275–280. doi:10.1001/archpedi.1963.02080040277009
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