Study of dimorphic anemia in adults with reference to basic etiology

Objective: To investigate the basic cause of dimorphic anemia in adult patients using hematological parameters, bone marrow iron stores, serum vitamin B12 and folate assays. Materials and Methods: Hematological parameters and bone marrow, serum vitamin B12 and folate assays of 62 patients with dimorphic anemia were studied to evaluate the basic etiology in dimorphic anemia. Results: The mean MCV was 95.01±13.14fl and MCV was normal in 56.45% cases. BM examination showed megaloblastic maturation in 32.36%, megaloblastic with micronormoblastic maturation in 64.52% cases. BM iron stores were deficient in 32.26% cases. 43.55% cases had only folic acid deficiency, 19.35% cases had only B12 deficiency and 27.42% cases had both B12 and folate deficiency. Combined iron and vitamin deficiencies in 25.8% cases. The mean MCV, MCH, MCHC and RDW were significantly high in combined deficiencies. Conclusion: The common basic cause for dimorphic anemia was folate deficiency. MCV is unreliable as a screening parameter for anemia with vitaminB12 or folate deficiencies. Concomitant deficiencies of B12 or folate with iron deficiency are not infrequent; one type of anemia may mask the other. Serum assays will be appropriate to establish the cause in cases with concomitant deficiencies, as it may result in discordant results with various other tests like hematological parameters.