Importance Of PLT/MCH Ratio to Differentiate Isolated B12 Deficiency From B12 Deficiency Combined with Other Causes

  • Asma Sheikh, Dr JSMU
  • Suresh Kumar JSMU
  • Zareen Irshad, Dr JSMU
  • Nadeem Nusrat Fazaia Medical College
  • Salma Perveen Jinnah Sindh Medical University
  • Sadaf Razzak JSMU
  • Syed Mehmood Hasan, Professor Jinnah Sindh Medical University
Keywords: Vitamin B12, MCV, PLT/MCH ratio


Objective: To explore the importance of platelet/mean corpuscular haemoglobin ratio to distinguish between isolated B12 deficiency from combine B12 with iron or B12 with beta thalassaemia trait

Methodology: Two types of cases were selected including isolated B12 deficiency and B12 deficiency combined with iron deficiency or beta thalassemia trait. A total of 105 cases were included. Complete blood counts were done including red cell indices, serum ferritin and Hb electrophoresis. Two arms were compared with each other with a p value less than 0.05 considered as significant.

Results: Mixed deficiencies group of B12 showed decreased haemoglobin level, mean corpuscular volume, mean corpuscular haemoglobin,and mean corpuscular haemoglobin concentration and increased platelet count as compared to solo B12 deficient group. CBC indices indicated that PLT/MCH ratio parameter was higher in value in combined deficiencies as compared to B12 deficiency alone.

Conclusion: It was concluded that with the help of Platelet/mean corpuscular haemoglobin ratio and hemogram indices, we can distinguish simple B12 deficiency from complicated B12 with iron deficiency or beta thalassaemia trait on the basis of complete blood count. Physicians should keep in mind these indices and ratio to distinguish mixed deficiencies on routine blood count thus initiating timely further management.


- Beyan C, Kaptan K, Beyan E, Turan M. The platelet count/Mean corpuscular Hemoglobin ratio distinguishes combined iron and vitamin B12 deficiency from uncomplicated iron deficiency. Int J Hematol.2005; 81(4): 301-303

- Second international conference on nutrition (ICN2)

- National nutrition survey 2018/UNICEF Pakistan.

- Ando M, Tamayose K, Sugimoto K, Oshimik. Masked deficit of B12 and folic acid in thalassaemia. A J Hematol. 2001; 67: 273-278

- Chan CJ, Liu SY, Kho CS, Lau KH, Liang YS, Chu W. Dignostic clues to megaloblastic anaemias without macrocytosis. Int J Lab Hematol. 2007; 29(3):163-71

- Shaikh A, Nusrat N, Agha MA, Shabbir A. Iron deficiency and thalassaemia trait in vitamin b12 deficient with normal or low mean corpuscular volume. Professional Med J. 2018;25(12):1863-1868 DOI:10.29309/TPMJ/18.4672

- Akhtar S, Ahmed A, Ahmed A, Ali Z, Riaz M, Ismail T. Iron status of the Pakistani population-current issues and strategies. Asia Pac J Clinc Nutr. 2013;22(3):430-347

- Khatoon S,Ahmed A,Yousaf S.Iron deficiency anaemia in Pakistan:Celiac disease an underlying cause. J Ayub Med Coll Abbottabad. 2018;30(3):372-376

- Ansari T, Ali L, Aziz T, Ara J, Liaquat N, Tahir H. Nutritional iron deficiency in women of child bearing age- What to do? J Ayub Med Coll Abbottabad. 2009;21 (3): 17-20

- MI/UNICEF. Vitamin and mineral deficiency. A global progress report. 2004

- Federal Bureau of statistics. Pakistan integrated household Survey. Government of Pakistan. Islamabad. Pakistan; 1991

- Kundi A. 50 pc of children under five die of malnutrition every year. PakistanToday,Oct17,2011.[cited2013/2014];Availablefrom.http://www.pakistan

- Molla A, Khurshid M, Molla AM. Prevalence of ID anemia in children of the urban slums in Karachi. J Pak Med Assoc. 1992; 42(5) :118-21

- Rahbar MH, Hozhabri S, Wang J. Prevalence of anemia among children living in five communities in and near Karachi, Pakistan. Toxicol Envoirn Chem. 2007; 89:337-46

- Paracha PI, Hameed A, Simon J, Jamil A, Nawab G. Prevalence of anaemia in semi- urban areas of Peshawar, Pakistan: A challenge for health professionals and policy makers. J Pak Med Assoc. 1997; 47(2): 49-53

- Huma N, Rehman SU, Anjum FM, Murtaza MA, Sheikh MA. Food fortification strategy-preventing IDA: A review. Crit Rev Food Sci Nutr. 2007; 47(3):259-65

- WHO 2008. World wide Prevalence of Anemia.1993-2005. WHO Global Dtabase on Anemia[cited2013/3/20];Availablefrom

- Majeed T, Akhter AM, Nayyar U, Riaz SM. Frequency of β-Thalassaemia trait in families of thalassemia major Pakistan,Lahore.J Ayub Med Coll Abbottabad. 2013;25(3-4):58-60

- Ansari SH, Shamsi TS, Ashraf M, Farzana T. Molecular epidemiology of β-thalassaemia in Pakistan:Far reaching implications. Indian J Hum Genet. 2012;18(2):193-197 doi:10.410310971-6866.100762

- Agarwal A, Shrivastava J, Rashmi D, Akhil S. Masked megaloblastic anaemia presenting as acute flaccid paralysis in a child with thalassaemia. Asian J Ch Pediatr Neonatol. 2013;1 (2)

- Cazzola M, Alessandrino P, Barosi G, Morandi S, Stefaneli M . Quantitative evaluation of the mechanisms of the anaemia in heterozygous beta thalasaemia. Scand J Haematol. 1979; 23(2):107-14

- Vinayak W, Patil, Shahid A, Mujawar. Deficiency of folic acid , vitamin B12 and their correlation with ferritin in childhood beta thalassemia major. Current Pediatric Research. 2010; 14 (2): 111-14

- Ando M, Tamayose K, Sugimoto K, Oshimik. Masked deficit of B12 and folic acid in thalassaemia. Am J Hematol. 2001; 67(4): 273-278

- Tavil B, Sipahi T. Masked deficit of vitamin B12 in a Turkish girl with thalassaemia. Pediatar Hematol Oncol. 2004; 21 (4): 363-5

- Bilic E, Bilic E, Zagar M, Juric S. Masked deficit of vitamin B12 in the patient with heterozygous beta thalasemia and spastic paraparesis.Acta Neurol Belg.2004;104(4):173-5

- Jolobe OM. Prevalence of hypochromia (without microcytosis) versus microcytosis (without hypochromia) in iron deficiency .Clin Lab Haematol. 2000; 22(2):79-80

- Akan H, Guven N, Aydogdu I, Arat M, Besksac M, Dalva K. Thrombopoietic cytokines in patients with iron deficiency anemia with or without thrombocytosis. Acta Haematol 2000;103(3):152-6

- Evstatiev R, Bukaty A, Jimenez K, Kulnigg-Dabsch S, Surman L,Schmid W, Iron deficiency alters megakaryopoiesis and platelet phenotype independent of thrompoietin. Am J Hematol. 2014;89(5):524-9

- Lardhi A, Ali R, Mohammed T. Thalassaemmia minor presenting with vitamin B12 deficiency, paraparesis and microcytosis. J Blood Med. 2018; 9:141-144 doi:10.214/JBMS163722

- Bilic E, Bilic E,Zagar M, Juric S. Masked deficit of vitamin B12 in the patient with heterozygous beta thalasemia and spastic paraparesis.Acta Neurol Belg. 2004;104(4):173-5

- Song SM, Bae KW, Yoon HS, Im HJ, Seo JJ. Acase of anemia caused by combined vitamin B12 and iron deficiency manifesting as short stature and delayed puberty. Korean J Pediatr. 2010;53(5):661-665

How to Cite
Sheikh, A., Kumar, S., Irshad, Z., Nusrat, N., Perveen, S., Razzak, S., & Hasan, S. (2020). Importance Of PLT/MCH Ratio to Differentiate Isolated B12 Deficiency From B12 Deficiency Combined with Other Causes. Annals of Jinnah Sindh Medical University, 5(2), 77-82. Retrieved from

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