Megaloblastic anemia with pancytopenia in infancy:a rare entity

Megaloblastic anemia in infants present with generalized weakness, failure to thrive, or irritability. Diagnosis is usually centered on complete blood count and peripheral smear, which may show macrocytes, hyper segmented neutrophils, reticulocytopenia and a raised mean corpuscular volume (MCV >100 fl). Pancytopenia has also been noted.We report an exclusively breast fed six months old female child who presented with irritability, poor feeding and developmental delay. Her initial blood picture revealed pancytopenia, with normal MCV. Vitamin B12 levels were found to be reduced. Maternal levels of Vitamin B12 were also found to be borderline low. The child was treated as per protocols and improvement was evidenced with return of hematological parameters to normal and gradual advancement of milestones. The authors wish to underscore the importance ofMegaloblastic anemia as an important and rare cause of anemia in infancy. Early recognition and treatment are imperative to prevent catastrophic sequelae.