A practical approach to the differential diagnosis and evaluation of the adult patient with macrocytic anemia

Colon-Otero, G.; Menke, David H.; Hook, C. Christopher

doi:10.1016/s0025-7125(16)30341-8

Cited by 69 publications

(52 citation statements)

References 31 publications

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“…In these patients, macrocytosis is considered a surrogate marker indicating the patients compliance in taking medications [1,3]. Colon-Otero et al [18] have reported that 60% patients with macrocytosis present without anemia. In the present study, 83 cases (46.7%) presented without anemia and the remaining 95 cases (53.3%) had associated anemia.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Macrocytosis in Routine Hemograms

Veda

2012

Indian J Hematol Blood Transfus

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Macrocytosis, a condition in which erythrocytes are larger than normal manifests as an increase in mean corpuscular volume (MCV) more than 100 fl. The aim of this study was to identify the underlying causes of macrocytosis, detected in routine hemograms and to evaluate the hematological features in different etiologies. This study included 178 adult patients whose detailed medical history was recorded, and Vitamin B12 assay, folate assay, thyroid function tests, liver function tests, complete blood counts and peripheral smear evaluation was performed. Alcoholism was identified as the etiological factor in 65 cases (36.5%), Vitamin B12 deficiency in 43 cases (24.1%) and drug related in 23 cases (12.9%). These three conditions accounted for 73.6% of macrocytosis. Other causes identified were folate deficiency, liver disease, Myelodysplastic syndrome, chronic renal failure and Aplastic anemia. In 41 cases, the cause of macrocytosis could not be explained. Anemia was observed in 95 cases (53.3%) being most common in Vitamin B12 deficiency. 9 cases (20.9%) of Vitamin B12 deficiency presented with isolated macrocytosis without anemia. It was observed that mean hemoglobin was lower and red cell distribution width (RDW) higher in megaloblastic conditions. Peripheral smear revealed hypersegmented neutrophils in 86% and macroovalocytes in 72% of the megaloblastic cases. Complete medical history, red cell parameters and peripheral blood smear are simple, inexpensive tools which assist in identifying the underlying cause of macrocytosis, particularly in resource limited settings. Macrocytosis needs to be evaluated even in the absence of anemia, as it may be the first clue to an underlying pathology.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Macrocytosis in Routine Hemograms

Veda

2012

Indian J Hematol Blood Transfus

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“…Patients with megaloblastic anemia confi rmed by bone marrow examination were subjected to a therapeutic trial with full replacement doses of vitamin B 12 injections (1 mg of cyanocobalamin intramuscularly for 10 days) and, in case of a suboptimal or absent response to cyanocobalamin, followed by 1 mg of folic acid orally for 10 days to identify the cause of megaloblastosis [9]. The patients who had concomitant iron defi ciency, as shown by a low serum iron levels or, more specifi cally, a decreased marrow iron stores -grade 3 or less -were given iron supplementation in the form of ferrous sulphate tablets 200 mg thrice a day in the intensive phase of vitamin supplementation and continued upto 3 months.…”

Section: Methodsmentioning

confidence: 99%

“…McPhedran (1973), Davidson (1978) and Colon-Otero et al (1992) have variously described their fi ndings in patients with macrocytosis [2,3,9]. McPhedran defi ned the cause of macrocytosis in the absence of anemia in 100 consecutive patients and reported that the most common cause of macrocytic anemia was megaloblastic anemia due to vitamin B 12 and folate defi ciency [2].…”

Section: Etiology Of Macrocytic Anemiamentioning

confidence: 99%

“…McPhedran defi ned the cause of macrocytosis in the absence of anemia in 100 consecutive patients and reported that the most common cause of macrocytic anemia was megaloblastic anemia due to vitamin B 12 and folate defi ciency [2]. On the other hand, alcohol abuse was the most common cause of macrocytosis as per Colon-Otero, followed by vitamin B 12 and folate defi ciency [9]. In the large study by Savage et al in 2000, the most common cause of macrocytosis was drug therapy, followed by alcohol liver disease, and reticulocytosis [11].…”

Section: Etiology Of Macrocytic Anemiamentioning

confidence: 99%

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Clinico-aetiologic profile of macrocytic anemias with special reference to megaloblastic anemia

Unnikrishnan

Dutta

Badhe

et al. 2008

Indian J Hematol Blood Transfus

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Purpose of study This study was conducted to study the clinical and laboratory parameters in patients with macrocytic anemia and to determine the etiology of macrocytic anemia with special reference to megaloblastic anemia. Materials and methodsThis study was a cross-sectional descriptive study carried over a period of 18 months on 60 adult patients (age ≥13 years) of macrocytic anemia. Macrocytic anemia was identifi ed when peripheral blood examination showed anemia with a mean red blood corpuscular volume of >95 fl .Result The most common cause of macrocytic anemia was megaloblastic anemia (38.4%). The major causes of nonmegaloblastic macrocytic anemia were primary bone marrow disorders (35%), liver diseases (15%) and hemolytic anemia (8.3%). There was a signifi cant male preponderance in the study (65%). The megaloblastic anemias observed were due to either vitamin B 12 defi ciency (78.3%) or combined B 12 and folate defi ciency (21.7%). A signifi cant proportion of non-vegetarians (73.9%) had megaloblastic anemia.Patients with an MCV of >110fl were more likely to have megaloblastic anemia (p value 0.0007). Three patients (mean age 55 years) with a megaloblastic marrow did not respond to vitamin replacement and were found to have myelodysplastic syndrome.Conclusion Megaloblastic anemia due to Vitamin B 12 or folate defi ciency remains the most important cause of macrocytic anemia. In settings with limited laboratory facilities, a therapeutic trial of vitamins B 12 or folic acid is useful in determining the specifi c vitamin defi ciency.

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“…3,7,8 Its significance tends to be underestimated by physicians, since about 60% of patients present without associated anemia, 8 unless there are other accompanying abnormalities noted.…”

Section: Clinical Significancementioning

confidence: 99%

Megaloblastic Anemia and Other Causes of Macrocytosis

Aslinia¹,

Mazza²,

Yale³

2006

Clinical Medicine & Research

274

214

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The term macrocytosis refers to a blood condition in which red blood cells (RBC) are larger than normal. Macrocytosis is reported in terms of mean corpuscular volume (MCV). Normal MCV values range from 80 to 100 femtoliters (fl) and vary by age and reference laboratory. 1 MCV is calculated according to the following formula:Macrocytosis can be identified by reviewing peripheral blood smears and/or by automated RBC indices. The peripheral blood smear is more sensitive than RBC indices for identifying early macrocytic changes because the MCV represents the mean of the distribution curve and is insensitive to the presence of small numbers of macrocytes. 2 However, compared to the peripheral blood smear, MCV may underestimate macrocytosis in over 30% of cases. 3 Although determination of the MCV by automated blood cell counter is rarely inaccurate, hyperglycemia, marked leukocytosis and cold agglutinins may result in false elevations of the MCV. [4][5][6] Moreover, partial occlusion of the instrument aperture and/or leaving the blood sample at room temperature for several hours may also result in false elevations of the MCV value. Clinical SignificanceMacrocytosis is a relatively common finding in the era of automated blood cell counters, with prevalence estimates ranging from 1.7% to 3.6%. 3,7,8 Its significance tends to be underestimated by physicians, since about 60% of patients present without associated anemia, 8 unless there are other accompanying abnormalities noted.No complications arise from macrocytosis itself as an isolated finding. However, its identification can provide important information regarding the presence of an underlying disease state. Thus, in the appropriate clinical setting, MCV values above the upper limit of normal or those that differ significantly from the patient's baseline values may require further clinical and laboratory assessment to determine the underlying cause of the macrocytosis. 9

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A practical approach to the differential diagnosis and evaluation of the adult patient with macrocytic anemia

Cited by 69 publications

References 31 publications

Evaluation of Macrocytosis in Routine Hemograms

Evaluation of Macrocytosis in Routine Hemograms

Clinico-aetiologic profile of macrocytic anemias with special reference to megaloblastic anemia

Megaloblastic Anemia and Other Causes of Macrocytosis

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