Morphological and biochemical profile of anaemia- Does it help a step further in under diagnose cases in a hospital based study

Introduction: Anaemia is one of the preventable disease burden worldwide, especially in developing nations like India. There are varied aetiologies for anaemia; Iron deficiency being the most common cause. Age, sex, geographical and comorbid factors play important role in the morphological patterns of anaemia. Anaemia, if undetected can cause morbidity and mortality which can be prevented. Aims and objectives: To identify morphological patterns and severity of anaemia in patients of all age groups andcorrelate the findings of automatic hemoanalyser, peripheral smear and biochemical parameters like iron studies, vitamin B 12 and folic acid; to correlate these findings with age, sex, morphological type and to find out the commonest pattern. Materials and Methods: This cross sectional study comprised of 300 anaemic patients over a period from December 2015 to July 2017 in Mahatma Gandhi Medical College and Research Institute, Pondicherry. Results: In our study of 300 cases, microcytic hypochromic anaemia was the commonest anaemia in all age groups (66%), followed by dimorphic anaemia (23%). Also, prevalence of microcytic hypochromic anaemia was highest in our study (p value<0.005) as compared to other studies. Two (1.01%) of 197 microcytic hypochromic cases showed elevated levels of Iron ferritin and increased saturation and decreased TIBC suggesting thalassemia trait. Remaining 195 microcytic hypochromic anaemic cases showed reduced levels of serum Iron, ferritin and increased levels of TIBC. Amongst 23% dimorphic anaemia, 76.4% patients showed reduced levels of serum Iron and ferritin with increased TIBC, 7.3% showed reduced levels of vitamin B 12, 10.2% showed reduced folate levels. Among 8% patients with Macrocytic anaemia, 80% patients had both vitamin B12 and folate deficiency, 12% had folate deficiency alone, 8% patients showed normal vitamin B 12 and folate levels. Normocytic normochromic anaemia accounted to 3%, of which 5 cases showed reticulocytosis, indicating hemolytic anaemia. Regarding age, majority were adults, in which female predominance was seen (M:F ratio is 1:1.8),majority(68.3%) showed severe degree of anaemia. Conclusion: In this hospital study, microcytic hypochromic anaemia was the most common morphological type of anaemia in which two asymptomatic cases of presumptive Thalassemia trait detected due to correlation between complete blood count, peripheral smear study and further biochemical studies. These correlations proved to be definitive in establishing diagnosis of aetiology of anaemia.This inclusive approach towards conclusive diagnosis of anaemia will help to lessen the burden associated with it.