DOWNLOAD PDF MACROCYTOSIS AND MACROCYTIC ANAEMIA

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1 Chapter 1 : Macrocytic Anemia- Causes, Symptoms Treatment Macrocytosis is a term used to describe red blood cells that are larger than normal. Anemia is when you have low numbers of properly functioning red blood cells in your body. Macrocytic anemia. Macrocytosis Treatment Macrocytosis Definition One who would feel the need to enquire as to what is macrocytosis, must be informed of the fact that it is a condition related to the unusual enlargement of the RBC count or erythrocytes in blood, thereby leading to the deficiency of oxygen in the body. It is usually characterized by a near-constant level of haemoglobin. One may define macrocytosis by a MCV or mean corpuscular volume of more than femtolitres. Macrocytosis without anaemia is usually the most common occurrence but when macrocytosis is associated with reduced levels of haemoglobin, it is referred to as Macrocytic anaemia. One may classify Macrocytic anaemia as megaloblastic and non-megaloblastic. The former is associated with an abnormality related to the erythroblasts that is actually triggered by a poor synthesis of DNA. It is for this reason that macrocytosis is also known as megaloblastic anaemia. The non-megaloblastic form of anaemia occurs either due to insufficient or failure of the synthesis of haemoglobin but where the impairment of DNA synthesis does not take place. It may also be a case of normocytic anaemia. Some of the most common symptoms of macrocytosis include fatigue, feebleness, and lack of concentration, dizziness, digestive problems, pallor, and breathing problems. One may also exhibit diarrhoea and constipation, bleeding gums, and swollen tongues in case of this condition. However, severe macrocytosis may exhibit severe neurological problems leading to confusion, loss of balance, depression, dementia, and tingling or numbness. These symptoms may assume permanence if left untreated on time. Macrocytosis Causes The causes of macrocytosis may be basically grounded in the deficiency of folic acid and vitamin B 12 in the blood that are actually responsible for the formation of red blood cells. A more effective analysis of the causes of the same may reveal the exact causes of the same. The nutritional deficiency may actually be triggered by a hereditary problem known as Pernicious anaemia. Some of the hematologic causes of macrocytosis actually incur due to problems associated with the bone marrow and blood. Some of them include myelodysplasia, leukaemia, myelofibrosis, and pernicious anaemia. Chronic alcoholism is considered to be a significant factor behind the occurrence of macrocytosis alcohol. Besides these, some of the other causes of macrocytosis include malnutrition in infancy, diet lacking in B12, liver problems, obstructive jaundice, and the deposition of phospholipids, reticulocytosis and hypothyroidism. One may also suffer from macrocytosis during pregnancy which may normalize slowly and steadily post-partum. Autoimmune disorders such as diabetes may also be a significant cause of the same. Undergoing chemotherapy may also cause macrocytosis as side-effect. Severe macrocytosis may also be caused due to a chronic obstructive pulmonary disease COPD, accelerated erythropoiesis, bacterial or parasitic infestation, and life-threatening HIV infection. Macrocytosis Differential Diagnosis A differential diagnosis of macrocytosis is sought for the purpose of differentiating it from the other kind of macrocytosis and other associated diseases and disorders. The cause of macrocytosis may first be analysed by a full blood count test of a blood film. This may be followed by a bone marrow examination to make the distinction between the two kinds of macrocytosis more explicit. Macrocytosis Treatment The treatment of macrocytosis depends on the cause and severity of the condition. Effective treatment of the ailment actually lies in the treatment of the underlying diseases and disorders causing the same. Mild macrocytosis may be treated with the help of vitamin injections to compensate the loss of vitamin B One may also be prescribed oral and nasal supplements of vitamin B12 and a balanced diet rich in the same nutrient. These injections may be administered either on a short term or a long term basis depending on the cause. One may also undertake some measures for preventing the occurrence or severity of the condition such as avoiding the consumption of alcohol, and taking proper surgical aftercare measures. All such measures shall help one avert severe complications associated with macrocytosis such as stomach polyps and cancer, which are by themselves life-threatening. Page 1

2 Chapter 2 : Macrocytosis - Symptoms,Causes,Diagnosis And Treatment Macrocytic anaemia describes a macrocytosis associated with a reduced haemoglobin and most commonly occurs as a result of a megaloblastic anaemia. Macrocytic anaemia can be classified as megaloblastic and non-megaloblastic. Over the years, doctors have learned that some types of anemia are consistently associated with red blood cells that are larger than normal. These conditions are collectively called macrocytic anemias and their treatment typically depends on their underlying cause. Normal Large Red Blood Cells Red blood cells originate in your bone marrow, where any number of factors or conditions can interfere with their production and alter their size, shape or hemoglobin content. When macrocytes -- large red blood cells -- are discovered in your circulation, your doctor must first decide if they are associated with an underlying medical problem. Babies, children and pregnant women often have enlarged red cells but have no condition that might cause it, and many healthy people inherit the tendency to make macrocytes. If your macrocytes are associated with anemia, your doctor may order further tests. Bone Marrow Changes Once macrocytic anemia has been diagnosed, the next step is to determine whether it is megaloblastic or nonmegaloblastic. Megaloblasts are abnormally large, immature red blood cells in your bone marrow, and their presence can only be detected with a bone marrow biopsy. But the process that produces megaloblasts -- interrupted red cell maturation due to impaired production of DNA -- also affects other cells, such as white blood cells. So, finding specific types of abnormal white blood cells in your circulating blood reliably predicts whether you have megaloblastic or nonmegaloblastic anemia. This distinction offers a hint about the underlying cause of your macrocytic anemia. Alcoholism is the most common cause of nonmegaloblastic macrocytic anemia. Many medications, such as methotrexate Rheumatrex, phenytoin Dilantin and several anti-hiv drugs, cause megaloblastic macrocytic anemia. The most common nutritional causes of macrocytic anemia are vitamin B12 and folate deficiencies, both of which cause megaloblastic anemia. Primary bone marrow disorders, such as leukemia or myelodysplasia, typically cause megaloblastic macrocytic anemia. Liver disease and hypothyroidism are chronic disease states that cause a macrocytic anemia which is nonmegaloblastic. Considerations The divisions between nonmegaloblastic and megaloblastic anemias, as well as the distinctions among macrocytic, normocytic and microcytic anemias -- large, normal and small red blood cells, respectively -- are somewhat artificial, as the same disease could provide different pictures at various points in time. For example, while alcoholism alone may cause nonmegaloblastic macrocytic anemia, people who abuse alcohol are often folate-deficient, as well, which could trigger a megaloblastic macrocytic anemia. Similarly, a primary bone marrow disease, like leukemia, may initially be associated with macrocytic anemia. As your bone marrow is progressively replaced by leukemia cells, your remaining red blood cells might have a variety of shapes and sizes, including many that are too small. So, while macrocytosis offers some direction in diagnosing the cause of anemia, it is only one clue. Page 2

3 Chapter 3 : Vitamin B12 deficiency anemia: MedlinePlus Medical Encyclopedia The term macrocytic is from Greek words meaning "large cell". A macrocytic class of anemia is an anemia (defined as blood with an insufficient concentration of hemoglobin) in which the red blood cells (erythrocytes) are larger than their normal volume. Types Doctors classify macrocytosis into two broad categories: Megaloblastic macrocytosis is the most common form. It occurs when DNA cannot be produced because of a vitamin deficiency. Nonmegaloblastic macrocytosis, which can happen when there is a problem with the liver, spleen, or bone marrow. Treatment When a person shows signs of macrocytic anemia, a doctor will take several blood tests to find the underlying cause. In most cases, vitamin injections are the first line of treatment. Injecting vitamins ensures the body can absorb these even if an underlying condition, such as celiac disease, prevents vitamin absorption. Eating more foods containing vitamin B may improve symptoms if a person is deficient in this vitamin because of their diet. Other treatment options include: When the blood does not have enough hemoglobin, it will not have enough oxygen. The body may try to fix this by increasing the heart rate or blood pressure. Left untreated, anemia can cause heart failure, an enlarged heart, and circulatory problems. When macrocytic anemia is due to a problem with the bone marrow or an organ, this underlying cause can trigger further complications. For example, people with untreated bone marrow disorders may develop leukemia. Most cases of macrocytic anemia are due to vitamin deficiencies, which can cause different complications depending on the vitamin: Vitamin B deficiencies A vitamin B deficiency can cause: While most people recover with prompt treatment, they may need periodic checks for anemia. When macrocytic anemia is due to an underlying disease, the outlook depends on what disease is causing the deficiency, and how it is treated. Macrocytic anemia often goes undiagnosed until it becomes severe. People who have symptoms of anemia, a family history of anemia, or who have or are at risk of a condition linked to macrocytic anemia should see a doctor for a blood test. Most cases of anemia can be easily diagnosed and treated. Page 3

4 Chapter 4 : Macrocytic Anemia Macrocytic anemia is a type of anemia characterized by abnormally large red blood cells. The size of the red blood cells means there are fewer of them to help the body function. In this article. Fitness Macrocytic Anemia- Causes, Symptoms Treatment You may know about microcytic anemia but what is macrocytic anemia? Let us know about this anemia, which is one of the various types of anemia. Sponsored link What is Macrocytic Anemia? Macrocytic anemia is a medical condition characterized by the enlargement of red blood cells with lower hemoglobin levels necessary to carry the oxygen all over the body. The condition will result due to lack of folate, vitamin B12, malabsorption deficiency as well as some medications that greatly affect the levels of folic acid in your body. Symptoms of Macrocytic Anemia Depressed appetite is one of the initial symptoms of this type of anemia which result to fatigue due to less food consumption. In addition, nails on toes and fingers become brittle, coupled with skin discoloration like paleness on the area of the face most particularly on the lips; weakness, smooth and sore tongue and mouth as well as nausea. Further symptoms manifest over time. Causes The condition is a strong indication of improper development of your red blood cells in which they lost their nuclei causing their size to decrease during the natural growth process. The lack of essential nutrients such as folate or Vitamin B12 is the common cause why this condition occurs. Yet, it may also be the result of any recent intake of cancer drugs and abuse of alcohol. Folate deficiency occurs because of folate malabsorption due to celiac disease, which harms the cells where folate absorption occurs. However, deficiency occurs when your diet lacks vitamin B12 and absorption difficulties. These drugs inhibit the cancer cells to build DNA; the drugs have similar effects to the cells of the body, including the red blood cells as well as cells on the digestive tract. On the other hand, alcohol also gets in the way of using folate in the body. Complications Folate and Vitamin B12 are essential nutrients for healthy nerves and long-term deficiency of these essential nutrients will result into tingling toes and fingers as well as numbness. If left untreated, the condition aggravates to glove-and-stocking dissemination. In severe cases, confusion and even paranoia happens. Moreover, folate deficiency during pregnancy can cause neural tube defects like spina bifida among infants. Treatment for Macrocytic Anemia and Prevention Treatments are only initiated once the causes are discovered. Furthermore, injections of Vitamin B12 may be recommended for those suffering from pernicious anemia. Eating a balanced diet, which is a combination of green leafy veggies and animal proteins, is your finest shield against macrocytic anemia. If you are taking medications, it is best to discuss with your physician about folate or vitamin B12 supplementation as he or she is well aware of what is enough for your specific needs. Page 4

5 Chapter 5 : Anemia - Wikipedia Macrocytic anemia: Introduction. Macrocytic anemia: Macrocytic anemia is a blood disorder where the red blood cells are larger than normal but have low levels of haemoglobin which is needed to carry oxygen throughout the body. What Is Megaloblastic Anemia? Megaloblastic anemia is a type of anemia, a blood disorder in which the number of red blood cells is lower than normal. Red blood cells transport oxygen through the body. There are many types of anemia with different causes and characteristics. Megaloblastic anemia is characterized by red blood cells that are larger than normal. Because the cells are too large, they may not be able to exit the bone marrow to enter the bloodstream and deliver oxygen. Causes of Megaloblastic Anemia The two most common causes of megaloblastic anemia are deficiencies of vitamin B or folate. These two nutrients are necessary for producing healthy red blood cells. Vitamin B Deficiency Vitamin B is a nutrient found in some foods like meat, fish, eggs, and milk. Megaloblastic anemia caused by vitamin B deficiency is referred to as pernicious anemia. Folate is found in foods like beef liver, spinach, and Brussels sprouts. Folate is often mixed up with folic acid â technically, folic acid is the artificial form of folate, found in supplements. You can also find folic acid in fortified cereals and foods. Your diet is an important factor in making sure you have enough folate. Pregnant women are more likely to have folate deficiency, because of the high amounts of folate needed by the developing fetus. What are the differences between macrocytic anemia and microcytic anemia? Anemia is a term for low hemoglobin or red blood cells. Anemia can be divided into different types based on the volume of the red blood cells. Macrocytic anemia means that the red blood cells are larger than normal. In microcytic anemia, the cells are smaller than normal. We use this classification because it helps us to determine the cause of the anemia. The most common causes of macrocytic anemia are vitamin B and folate deficiency. Pernicious anemia is a type of macrocytic anemia due to the body not being able to absorb vitamin B Elderly, vegans, and alcoholics are more susceptible to developing macrocytic anemia. The most common cause of microcytic anemia is iron-deficiency anemia, usually due to poor dietary intake or blood loss, such as menstrual blood loss or through the gastrointestinal tract. Pregnancy, menstruating women, infants, and those with a diet low in iron may have an increased chance of developing microcytic anemia. Other causes of microcytic anemia include defects in hemoglobin production such as sickle cell disease, thalassemia, and sideroblastic anemia. Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice. Page 5

6 Chapter 6 : Macrocytosis: What causes it? - Mayo Clinic Types. There are actually two different types of macrocytic anemias, the Merck Manual says. The first type, known as megaloblastic macrocytic anemia, is the most common and is the result of vitamin deficiency such as B and folate. The red blood cells are critical for transporting oxygen throughout the body. Anemia describes any condition in which there is reduced red blood cell numbers, which can cause pallor and chronic fatigue. Macrocytic anemia is unique among types of anemia because of the appearance of larger than normal red blood cells. This kind of anemia needs to be treated based on the underlying disorder causing the problem. Types There are actually two different types of macrocytic anemias, the Merck Manual says. The first type, known as megaloblastic macrocytic anemia, is the most common and is the result of vitamin deficiency such as B and folate. The second type, known as non-megaloblastic macrocytic anemia, can be due to several different clinical problems, such as liver disease and problems with the bone marrow. In some cases, the cause of non-megaloblastic macrocytic anemia cannot be identified. Diagnosis Before macrocytic anemia can be treated, the exact type and cause should be identified in order for treatments to be effective. Diagnosing macrocytic anemia is typically done by performing what is known as a peripheral blood smear. On a blood smear, the size and number of the red blood cells can be determined. Megaloblastic macrocytic anemia is notable for the presence of small specks within red blood cells known as Howell-Jolly bodies, the Merck Manual reports, which are the result of immature red blood cells being released into the body to compensate for the anemia. Patients may also have their blood tested for vitamin deficiencies. Patients who have non-megaloblastic macrocytic anemia may need to have the health of their livers and bone marrow checked. Megaloblastic Short-Term Treatment Patients who have megaloblastic macrocytic anemia require immediate correction of their vitamin deficiency. If the megaloblastic anemia is due to a folate deficiency, this can be achieved by having the patient take folate supplements daily. A vitamin B deficiency can be somewhat harder to correct, however, and may require daily injections of the vitamin. Rarely, megaloblastic macrocytic anemia is the result of a deficiency in vitamin C, the Mayo Clinic says; these cases can be treated with oral vitamin C supplementation. Long-Term Control Patients with a vitamin B deficiency may suffer from an underlying disorder that prevents the body from absorbing B, MedLinePlus says. Long-term management of the associated macrocytic anemia thus depends on treating the cause of the vitamin B malabsorption. Patients with a B deficiency should be evaluated for these conditions to see if the anemia can be corrected without the use of lifelong vitamin supplementation. Non-Megaloblastic Macrocytic Anemia Non-megaloblastic macrocytic anemia can be more difficult to treat because it is not caused by vitamin deficiency disorders. Because this condition can be caused by liver disease, patients may need to have blood tests that check the health of the liver. Certain bone marrow diseases, including some leukemias, can also cause non-megaloblastic macrocytic anemia. These can be diagnosed using a bone marrow biopsy; treatment of bone marrow disorders can be complicated, depending on the type of disease present. Chapter 7 : Macrocytosis and Macrocytic Anaemia Patient What is Macrocytic Anemia? Macrocytic anemia is a medical condition characterized by the enlargement of red blood cells with lower hemoglobin levels necessary to carry the oxygen all over the body. Chapter 8 : Macrocytic anemia - Wikipedia Macrocytic Anemia is a type of anemia whereby the red blood cells produced by the body are very few and their size appears to be larger than the normal ones. The occurrence of this type of anemia can hence be described as macrocytosis, which may or may not be as a result of anemia. Chapter 9 : Macrocytic and Normocytic Anemia Page 6

7 A practical approach to the differential diagnosis and evaluation of the adult patient with macrocytic anemia. Med Clin North Am ; d'onofrio G, Chirillo R, Zini G, et al. Simultaneous measurement of reticulocyte and red blood cell indices in healthy subjects and patients with microcytic and macrocytic anemia. Page 7