Aim To elucidate the relation between vitamin D deficiency rickets and anaemia.

Methods Infants with rickets or hypocalcaemia seen in a 200 bed children's hospital were haematologically studied. All cases were divided into active or healed rickets according to radiological evidence.

Results The Hb ranged from 5 to 14 g/l and 48% of the cases of active rickets were considered in the range of anaemia, The mean haematological parameters as shown in the table 1 demonstrate a significantly low haemoglobin (Hb) level in active rickets at 10.48 g/l which is in the range of anaemia compared to 11.52 in healed rickets this difference is significant at p value of 0.037. When considering 10 g/l as cut off point 18 out of 30 (60%) are anaemic where as it was only 20% in the healed rickets group B.

Discussion The association of iron deficiency with rickets was reported by Grindulis et al1 in 1986 in England among Asian immigrants. One-fifth had both features of rickets and anaemia. This was more than simple overlap of the two deficiencies. In Ethiopia the association was as part of generalised malnutrition in contrast the study among immigrants in England and our findings previously and in this study where the was no protein calorie malnutrition. The condition known as Von Jaksch's anaemia was known in early 20s century but was not universally accepted as a disease entity related to rickets till it was reported as the northern syndrome. Presenting with haemolytic anaemia rickets, all responded to vitamin D therapy. Recently many cases of rickets and anaemia were reported as myelofibrosis with good response to vitamin D and calcium.

Conclusion From these findings we can conclude that three types of anaemia are associated with vitamin D deficiency rickets. First an iron deficiency anaemia due to having common nutritional and other factors, the second is haemolytic anaemia known as Northern syndrome that was reported among local American Indians, the other is a very rare anaemia due to myelofibrosis with involvement of platelets and neutrophils.