Macrocytic Anaemia

Question 1

Define macrocytic anaemia

Answer 1

Anaemia associated with a high MCV (>96fL) of RBC.

Question 2

What are the causes/risk factors of macrocytic anaemia?

Answer 2

Alcoholics May Have Liver Failure:
• Alcohol
• Myelodysplasia and Marrow infiltration
• Hypothyroidism and Haemolysis (with reticulocytosis).
• Liver Disease
• Folate and B12 Deficiency; drugs (e.g. methotrexate,
azathioprine) –Megaloblastic anaemia: a megaloblast is a cell in which nuclear maturation is delayed compared with the cytoplasm; there is a nucleo-cytoplasmic asynchrony since B12 and folate are required for DNA synthesis.

Question 3

What are the symptoms of macrocytic anaemia?

Answer 3

Non-specific signs of anaemia: tiredness, lethargy and dyspnoea. Also, there could be symptoms of B12 and folate deficiency

Question 4

What are the signs of macrocytic anaemia?

Answer 4

Non-specific signs of anaemia and signs of the cause

Question 5

What investigations are carried out for macrocytic anaemia?

Answer 5

• FBC - low Hb and High MCV.
• Myelodysplastic Syndrome: Associated neutropenia and thrombocytopenia with macroovalocytes.
• Investigations for macrocytic anaemia: B12 and Folate Deficiency. If the results are negative, investigate for other causes.

Other Investigations:
• A bone marrow biopsy is used to confirm Myelodysplastic syndrome.
• TFTs for hypothyroidism.
• LFTs for Liver disease.

Question 6

What is the management of macrocytic anaemia?

Answer 6

• treat cause e.g correct nutrient deficiency - supplements

Question 7

What are the complications of macrocytic anaemia?

Answer 7

• permenent damage to nervous system
• long-term neurological complications - peripheral neuropathy and dementia
• heart failure