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. 2009 Jan 11;24(4):155–165. doi: 10.1007/s12288-008-0039-2

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

Vineetha Unnikrishnan 1, Tarun Kumar Dutta 1,✉, Bhawana A Badhe 2, Zachariah Bobby 3, Ashish K Panigrahi 1
PMCID: PMC3475427  PMID: 23100955

Abstract

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 methods

This 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 identified 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 significant male preponderance in the study (65%). The megaloblastic anemias observed were due to either vitamin B12 deficiency (78.3%) or combined B12 and folate deficiency (21.7%). A significant 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 B12 or folate deficiency remains the most important cause of macrocytic anemia. In settings with limited laboratory facilities, a therapeutic trial of vitamins B12 or folic acid is useful in determining the specific vitamin deficiency.

Keywords: Macrocytic anemia, Non-megaloblastic macrocytic anemia, Bone marrow disorders, Megaloblastic anemia, Myelodysplastic syndrome

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References

  • 1.Lee G.R. Anemia: a diagnostic strategy. In: Lee G.R., Foerster J., Lukens J., Paraskevas F., Greer J.P., Rodgers G.M., Wintrobe M.M., editors. Wintrobe’s clinical hematology. 10th ed. Baltimore: Williams & Wilkins; 1998. pp. 908–940. [Google Scholar]
  • 2.McPhedran P., Barnes M.G., Weinstein J.S., Robertson J.S. Interpretation of electronically determined macrocytosis. Ann Intern Med. 1973;78:677–683. doi: 10.7326/0003-4819-78-5-677. [DOI] [PubMed] [Google Scholar]
  • 3.Davidson R.J.L., Hamilton P.J. High mean red cell volume: its incidence and significance in routine haematology. J Clin Pathol. 1978;31:493–498. doi: 10.1136/jcp.31.5.493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Hoffbrand V., Provan D. ABC of clinical hematology: Macrocytic Anaemias. BMJ. 1997;314:430–433. doi: 10.1136/bmj.314.7078.430. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Lindenbaum J. Status of laboratory testing in the diagnosis of megaloblastic anemia. Blood. 1983;61:624–627. [PubMed] [Google Scholar]
  • 6.Hall C.A. Vitamin B 12 deficiency and early rise in MCV. JAMA. 1981;245:1144–1146. doi: 10.1001/jama.245.11.1144. [DOI] [PubMed] [Google Scholar]
  • 7.Carmel R. Macrocytosis, mild anemia and delay in diagnosis of pernicious anemia. Arch Intern Med. 1979;139:47–50. doi: 10.1001/archinte.139.1.47. [DOI] [PubMed] [Google Scholar]
  • 8.Breedveld F.C., Bieger R., Wermeskerken R.K.A. The clinical significance of macrocytosis. Acta Med Scand. 1981;209:319–322. doi: 10.1111/j.0954-6820.1981.tb11599.x. [DOI] [PubMed] [Google Scholar]
  • 9.Colon-Otero G., Menke D., Hook C.C. A practical approach to the differential diagnosis and evaluation of the adult patient with macrocytic anemia. Med Clin North Am. 1992;76:581–597. doi: 10.1016/s0025-7125(16)30341-8. [DOI] [PubMed] [Google Scholar]
  • 10.Hattersley P.G. Macrocytosis of the erythrocytes: a preliminary report. JAMA. 1964;189:997–999. doi: 10.1001/jama.1964.03070130017004. [DOI] [PubMed] [Google Scholar]
  • 11.Savage D.G., Ogundipe A., Allen R.H., Stabler S.P., Lindenbaum J. Etiology and diagnostic evaluation of macrocytosis. Am J Med Sc. 2000;319:343–352. doi: 10.1097/00000441-200006000-00001. [DOI] [PubMed] [Google Scholar]
  • 12.Brigden M.L. A systematic approach to macrocytosis. Sorting out the causes. Postgrad Med. 1995;97:171–172. [PubMed] [Google Scholar]
  • 13.Davenport J. Macrocytic anemia. Am Fam Physician. 1996;53:155–162. [PubMed] [Google Scholar]
  • 14.Masalha R., Rudoy I., Volkov I., Yusuf N., Wirguin I., Herishanu Y.O. Symptomatic Dietary Vitamin B 12 Deficiency in a Non vegetarian Population. Am J Med. 2002;112:413–416. doi: 10.1016/S0002-9343(02)01031-8. [DOI] [PubMed] [Google Scholar]
  • 15.Matthews J.H., Wood J.K. Megaloblastic anaemia in vegetarian Asians. Clin Lab Haematol. 1984;6:1–7. doi: 10.1111/j.1365-2257.1984.tb00519.x. [DOI] [PubMed] [Google Scholar]
  • 16.Lindenbaum J., Healton E.B., Savage D.G., Brust J.C., Garrett T.J., Podell E.R., Marcell P.D., Stabler S.P., Allen R.H. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med. 1988;318:1720–1728. doi: 10.1056/NEJM198806303182604. [DOI] [PubMed] [Google Scholar]

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