Unexplained Macrocytosis in Elderly Patients

Mahmoud, Mohamed Y.; Lugon, Myriam; Anderson, C. C.

doi:10.1093/ageing/25.4.310

Cited by 38 publications

(30 citation statements)

References 9 publications

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“…However, their study has excluded drug induced causes. Mahmoud et al [16] have studied 124 patients in the age group of C75 years and found a higher incidence of hematological diseases and malignancy associated with macrocytosis. Breedveld et al [17] and Seppa et al [5] have reported Vitamin deficiency and alcoholism as the most frequent etiological factors, which is similar to the findings in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Though not specific for one condition, an elevated MCV of [100 fl, is a useful parameter directing further investigations which can ultimately lead to a definitive diagnosis in 75% of cases [16]. It may be the only indicator of vitamin deficiency and alcoholism [17].…”

Section: Discussionmentioning

confidence: 99%

“…It may be the only indicator of vitamin deficiency and alcoholism [17]. Mahmoud et al [16] believe that unexplained macrocytosis in the elderly (C75 years) could be an early sign of Myelodysplastic syndrome. Joseph et al [26] have observed that refractory, unexplained macrocytosis may be an early sign of smoldering leukemia.…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

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Evaluation of Macrocytosis in Routine Hemograms

Veda

2012

Indian J Hematol Blood Transfus

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“…[15]. In peripheral smear examinations, the presence of macro-ovalocytes with MCV more than 115 fL and hypersegmented neutrophils, along with anisocytosis and poikilocytosis affects a megaloblastic disorder associated with B12 or folate deficiency.…”

Section: Macrocytosis Can Be Identified By Two Methods-mentioning

confidence: 99%

Hypersegmented Neutrophils and Mean Corpuscular Volume in 100 Apparently Healthy Volunteers With Ethanol Abuse– An Analysis

S¹,

A²,

Lalitha³

et al. 2017

jemds

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BACKGROUNDAlcohol abuse is one of the reasons for medical and surgical illness in developing and developed countries. Haematological complications related to alcohol are manifold including macrocytic anaemia. The early indicator of anaemia in alcoholic individuals can be detected by monitoring Mean Corpuscular Volume (MCV) and observing peripheral smear for hypersegmented neutrophils. MATERIALS AND METHODSIn the present study, we analysed MCV and hypersegmented neutrophils in 100 alcoholics and compared it with 100 non-alcoholic individuals. RESULTSWe observed that MCV value was between 95 fL to 99 fL in 60 patients and 100 fL and above in 20 patients. Thus, MCV if observed in alcoholic individuals would warrant nutritional supplements, thereby secondary prevention of macrocytic anaemia would be made possible. Also, hypersegmented neutrophils were present in 67 alcoholic patients while only 11 control population had it in their peripheral smears. This suggests that peripheral smear analysis could be practised routinely in rural centres where higher end equipment is not available. Our results show a significant difference (p < 0.0001) in the MCV values and hypersegmented neutrophils between the test and control groups. CONCLUSIONThus, in a low resource setting, analysis for hypersegmented neutrophils in alcoholics and observing MCV values in them would help us predict the onset of macrocytic anaemia at a much early stage and treat them with nutritional supplements.

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“…); serum transferrin, B 12 and folic acid were measured by immunofluorescence on IMX (Abbott). Serum chemistry including creatinine, alkaline phosphatase, bilirubin, proteins, transaminase and lactate dehydrogenase were determined by Model 717 Automatic Analyzer (Hitachi).…”

Section: Hematological and Laboratory Determinationsmentioning

confidence: 99%

Prevalence and Survival of Myelodysplastic Syndrome of the Refractory Anemia Type in Hospitalized Cognitively Different Geriatric Patients

Beloosesky¹,

Cohen

Grosman³

et al. 2000

Gerontology

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Background: Myelodysplastic syndrome (MDS) is predominantly a disease of old age. The number of MDS cases diagnosed over the last 20 years has risen substantially due to increased awareness and improved geriatric care. Although MDS is increasingly diagnosed, the prevalence and prognosis of early-stage affected elderly are not completely known. Objective: To evaluate the prevalence, characteristics and prognosis of newly diagnosed MDS patients hospitalized in an acute and subacute geriatric department. Methods: Between 1993 and 1996, 3,275 patients hospitalized in the geriatric department of a teaching hospital for acute care or short-term rehabilitation were investigated for unexplained hematological abnormalities. Demographic, chronic comorbidities, cause of hospitalization, functional and cognitive status, hematological and other laboratory parameters were collected. Results: Two hundred and forty-five (7.5%) patients had unexplained cytopenia, macrocytosis or monocytosis, of whom 37 (15%) were diagnosed as having MDS. Only 9 patients were hospitalized for evaluation of anemia, 28 for infections, cardiac, cerebrovascular events and other causes. Thirty-four patients had refractory anemia (RA), two had RA with ringed sideroblasts and 1 had RA with an excess of blasts (RAEB). The follow-up period was up to 70 months. No differences were found between demented and cognitively normal patients in age, sex, comorbidities or laboratory parameters. Comparison of survival curves (excluding the RAEB case) according to demographic, clinical and hematological parameters has shown that only dementia adversely affects survival, compared to cognitively normal patients (p = 0.024). Conclusions: MDS of the RA type is a common and incidental finding in older hospitalized patients. It is a frequent cause of anemia and other hematological abnormalities but has less significance on survival rates than dementia, although its full impact remains to be determined.

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Unexplained Macrocytosis in Elderly Patients

Cited by 38 publications

References 9 publications

Evaluation of Macrocytosis in Routine Hemograms

Evaluation of Macrocytosis in Routine Hemograms

Hypersegmented Neutrophils and Mean Corpuscular Volume in 100 Apparently Healthy Volunteers With Ethanol Abuse– An Analysis

Prevalence and Survival of Myelodysplastic Syndrome of the Refractory Anemia Type in Hospitalized Cognitively Different Geriatric Patients

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