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Is Taking Vitamin B12 Safe For Increasing Hb While On Iron And Folic Acids Post Dengue?

Posted on Mon, 23 Dec 2013

Question: Hello. I live in the tropical island of Grenada My son had dengue in aug. We did a CBC yesterday and his platlets was72 and hb 6.9. He is on iron and folic acids for 4 weeks now. He has not taken in any dairy for that time. Can I give him vitamin b12 to help boast his hb

Answered by Dr. Anshul Varshney (37 minutes later)

Brief Answer: Megaloblastic anemia / Leukemia. Admit. Detailed Answer: Dear Ohenry. Your child had dengue in august, so it is unlikely that his platelet counts have not increased till december. Hb of 6.9 gm/dl and platelet count of 72,000 after 4 months of dengue requires evaluation. If his TLC count is also low, he has pancytopenia. I would recommend your child for a peripheral blood smear and a bone marrow aspiration examination and biopsy to rule out Megaloblastic anemia, Leukemias. Its always better to be sure. So, I recommend a bone marrow examination followed by blood transfusion at the earliest. Once the Bone marrow report is available, further treatment can be planned accordingly. No point in giving Vitamin B12, without knowing he has megaloblastic anemia or not. I hope i am able to answer your query, still if you have any query, please ask me, i will be happy to solve it. Stay Healthy

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Anshul Varshney (10 minutes later)

We did a bone marrow biopsy in August and step and it was normal. We also did two smear and that comeback alright. His platlet did went up to 125 July together with his hb of 8.9. He did had a blood transfusion in August when he was admitted to hospital. He hb has slowly been dropping since he had the dengue in August. It's just that now his platlets has again dropped but the rate at which his hb is dropping has slowed ( from1.9 points every four weeks to .3) we was making the mistake of giving him floic acid and iron together with milk but we changed that no and is giving him with juice. The doctors here said that he his not anemic. So I was wondering if it's because of his diet.

Answered by Dr. Anshul Varshney (11 minutes later)

Brief Answer: Repeat A Blood Picture Detailed Answer: Hi, If your child had anemia and low platelet count at the time of bone marrow examination, his bone marrow report can not be normal. It must have indicated the cause, Iron deficiency anemia or Megaloblastic anemia. I advise you to consider a repeat smear examination or repeat a bone marrow. Simply get his peripheral blood smear , RBC indices and a reticulocyte count from a reliable lab, that will clear most of the picture. If any doubts remain, we can get a bone marrow again. Hopefully it won't be required. If he has megaloblastic anemia, that can be easily treated. If report comes out to be megaloblastic anemia , discuss with your doctor for giving him injectable forms of Vitamin B 12 , And consider intrinsic factor deficiency too as a cause of megaloblastic anemia. There is no point in giving irrationally Vitamin B12 and Folic Acid. I hope i am able to solve your query , if you don't have further queries, please close the discussion and rate it. Stay Healthy.

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Above answer was peer-reviewed by : Dr. Raju A.T