Megaloblastic Anemia Complicating Thalassemia Major

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