Objective: This study explored the incidence, clinical features, and outcomes of hospitalized patients diagnosed with non-iron nutritional deficiency anemia at a major teaching hospital in Thailand.

Material and Method: Medical records of in-patient departments dated between January 2001 and June 2011 were retrospectively reviewed.

Results: One hundred and two cases were identified, including 40 patients with vitamin B12 deficiency, 46 with folate deficiency, and 16 with other nutritional deficiency anemias; corresponding incidence rates were 0.4, 0.6, and 0.2 cases per 100,000 per year, respectively. Patients with vitamin B12 deficiency were mostly female, while patients with folate deficiency were preponderantly male. Glossitis and pancytopenia were common characteristics of vitamin B12 deficiency cases, whereas alcohol abuse and cirrhosis were more frequent in folate deficiency cases, as expected. Serum ferritin levels were relatively high across all categories. A significant proportion of anemia cases across all subgroups presented concomitantly with anorexia or poor food intake, which indicates underlying nutritional problems in these patients. Survival of patients with folate and other types of nutritional deficiency anemia was lower than for patients with vitamin B12 deficiency anemia (hazard ratio [HR] and p-values were 2.65, 0.001 and 2.35, 0.023, respectively). Hemoglobin normalization in patients with vitamin B12 deficiency anemia could be achieved by intramuscular injection and oral vitamin B12 treatment in 55.56% and 33.33% (p = 0.248), with a median response time of 9 and 86 weeks (p = 0.151), respectively.

Conclusion: Non-iron nutritional deficiency anemia was not common in hospitalized patients in this study. Vitamin B12 injections resulted in faster responses, but with similar efficacy compared with oral treatments. Survival of patients with vitamin B12 deficiency anemia was significantly better than that of those with folate or other types of nutritional anemia.

Keywords: Nutritional deficiency anemia, Megaloblastic anemia, B12 deficiency, Clinical outcome, Thailand