Macrocytic Anemia - Diagnosis

10/6/00 - Del Rio

Group: Friday Interns

Presenting Intern: Christine Ko

RE: A 59 year old female with ataxic, wide-based gate.

Question: What are the causes of and diagnostic guidelines for macrocytic anemia?

Link Directly to Fulltext article in Ovid

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Unique Identifier: 20331543

Authors: Savage DG. Ogundipe A. Allen RH. Stabler SP. Lindenbaum J.

Institution: Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York, USA. savage@cuccfa.ccc.columbia.edu

Abstract: BACKGROUND: Elevation of mean cell volume (MCV) is a common clinical problem, but the etiologic spectrum and optimal diagnostic evaluation of macrocytosis are not well defined. METHODS: We studied 300 consecutive hospitalized adult patients with MCV values > or = 100 fL. Assessment included complete blood counts, morphologic review, liver function tests, and levels of serum cobalamin (Cbl), methylmalonic acid, and total homocysteine. RESULTS: The most common cause of macrocytosis was drug therapy, followed by alcohol, liver disease, and reticulocytosis. Megaloblastic hematopoiesis accounted for less than 10% of cases. MCV values > 120 fL were usually caused by Cbl deficiency. Anisocytosis, macro-ovalocytosis, and teardrop erythrocytes were most prominent in megaloblastic hematopoiesis. Elevated levels of serum methylmalonic acid and total homocysteine were useful in the diagnosis of Cbl deficiency. CONCLUSIONS: Drugs and alcohol are the most common causes of macrocytosis in hospitalized patients in a New York City teaching hospital. We have formulated tentative guidelines for the evaluation of high MCV values in this setting.