Study about the Syrian crisis effect in megaloblastic anemia incidence in university children’s hospital in Damascus

Abstract

Background: Megaloblastic anemia was frequently encountered when a complete blood count was conducted after the Syrian crisis, so it was necessary to shed light on the impact of the Syrian crisis on the occurrence of megaloblastic anemia.

Objective: To study the impact of the Syrian crisis on the increase in cases of megaloblastic anemia, and to know the reasons that contributed to the increase in the number of cases.

Materials and methods: A cross-sectional analysis study was conducted to study the cases of children with megaloblastic anemia admitted to the University Children's Hospital from the age of the newborn to 13 years from 2005 to 2011, as well as the cases of children admitted from 2011 to 2018, and a comparison was made between these two groups by referring to the age and clinical history, especially nutritional history, clinical examination and follow-up of laboratory test results (complete blood count - peripheral blood smear - bone marrow aspiration if performed - serum copolamine level - serum folate level - urinary excretion of uric acid if performed -  suppression test Deoxyuridine if done - titration of blood homocysteine ​​if done - titer of vitamin B12 in the mother in children who were breast-fed only) and in vivo investigations, particularly of the brain resonator, to determine the cause of megaloblastic anemia.

Results: The incidence of megaloblastic anemia extended to younger ages after the Syrian crisis, as it began to affect children from the age of 3 months compared to its occurrence from the age of 7 months after that, and vitamin B12 deficiency was dominant as a clear cause of megaloblastic anemia before and after the Syrian crisis by (91%) before the crisis and (82%) ) After that. child nutrition had an important role in the occurrence of megaloblastic anemia after the Syrian crisis, where the percentage of children who depended on parental feeding only without introducing complementary feeding in the second half of the first year of life after the Syrian crisis increased by (91%) compared to ( 62%) before that, and the percentage of children who adopt an unbalanced health system over the age of one year after the Syrian crisis increased by (76%) compared to (39%) before it. vitamin B12 deficiency in the mother after the Syrian crisis and her malnutrition also had an important role in the occurrence of megaloblastic anemia in children before the age of 6 months, as well as in children who depend on parental breastfeeding only in the second half of the first year, where the vitamin B12 titer was low among (77%) of the mothers of children who are breastfeeding, as well as over the age of one year, where the titer was low in (73%) of their mothers, and the percentage of megaloblastic anemia decreased after the Syrian crisis from (81%) before the crisis to (64%) after it. The percentage of mixed anemia (macrocytic and microcytic) increased from (19%) before the crisis to (36%) after it.

Conclusion: The Syrian crisis played an important role in the occurrence of macrocytic anemia by clearly affecting the nutritional status of the nursing mother and child.