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Anemia (Macrocytic)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Macrocytic anemia is characterized by large red blood cells, but with reduced hemoglobin levels. This cell malformation is due to inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage (G2) to the mitosis (M) stage. This leads to continuing cell growth without cell division, which presents as macrocytosis. Because the cells are abnormally large there are too few of them to carry adequate oxygen.
Nutritional Optic Neuropathy
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
William Sultan, Giulia Amore, Uchenna Francis Nwako, Stacey Aquino Cohitmingao, Samuel Asanad, Alfredo Sadun
The ophthalmological presentation of optic neuropathy is virtually indistinguishable from vitamin B12 deficiency, except for a more rapid time course. Mouth ulcers are more common than glossitis. Folate levels can be measured in serum and blood examinations may show macrocytic anemia. Oral folate supplementation is recommended.
Physiologic Changes
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Megaloblastic macrocytic anemia may be caused by deficiency of folic acid and vitamin B12 and by pernicious anemia. Nonmegaloblastic macrocytic anemia may be caused by alcoholism, hypothyroidism, liver disease, aplastic anemia, or increased reticulocyte count. The most common cause of onset of macrocytic anemia during pregnancy in the United States is folic acid deficiency [26]. During pregnancy, daily folic acid requirements increase from 50 μg to 400 μg [26]. Women who have had gastric surgery and those with Crohn disease may be at risk of vitamin B12 deficiency in pregnancy [26].
Plasma homocysteine levels and handgrip strength in postmenopausal women
Published in Climacteric, 2022
P. García-Alfaro, I. Rodriguez, F. R. Pérez-López
Vitamin B12 and folate deficiency causes macrocytic anemia and hyperhomocysteinemia [35]. In our study, we have used the MCV as a surrogate marker of plasma vitamin B12 and folate levels, and no case of macrocytosis was identified. Interestingly, our study found that the MCV was associated with a higher risk of hyperhomocysteinemia. Vitamin D has been also associated with homocysteine levels [36,37]; however, others have not found such relationships [38]. Amer and Qayyum reported a non-linear relationship between vitamin D and homocysteine, as it was only observed among those with plasma vitamin D levels that were ≤21 ng/ml [36]. In our cohort, there was no association between homocysteine and plasma vitamin D levels. This may be attributed to the fact that vitamin D levels were in the normal range and there were no women with very low plasma vitamin D levels.
Cobalamin and folic acid deficiencies presenting with features of a thrombotic microangiopathy: a case series
Published in Acta Clinica Belgica, 2022
Britt Ceuleers, Sofie Stappers, Jan Lemmens, Lynn Rutsaert
Physical examination was unremarkable except for obesity, extreme pale skin and mucosae. Vital signs were as follows: oxygen saturation 97%, heart rate 80/min and blood pressure 118/54 mmHg. Laboratory findings (Table 1) revealed a severe macrocytic anemia with findings consistent with hemolysis and a weak positive Direct Coombs test (strength 1+). Furthermore, there was a thrombocytopenia as well as a folate deficiency (<2.2 µg/L) with a normal vitamin B12 level (414 ng/L). Reticulocyte count was low and there was no evidence for leukocytopenia or lymphocytopenia. Additional laboratory findings showed normal kidney function (creatinine 0.84 mg/dl) and elevated iron levels. Peripheral blood smear findings did not detect schistocytes. Bone marrow examination confirmed megaloblastic anemia.
Hb Manitoba [α102(G9)Ser→Arg] in Pasifika: Tongan Case Report
Published in Hemoglobin, 2020
Beverley M. Pullon, Jordyn A. Moore
Previously described patients did not present with any clinical symptoms or hematological changes related to the variant [2,4–6,10]. The original British Canadian patient had macrocytic anemia but injections of B12 were able to restore his hematological status, leading to a diagnosis of pernicious anemia [1], while the mild anemia reported by Wong et al. [3] was also suggested to be unrelated. Nine of our 11 cases also presented without clinical symptoms or hematological changes. For one subject, abnormal RBCs were likely associated with iron deficiency; while for our case report, minor hypochromia and microcytosis were proposed to be caused by combined heterozygosity for Hb Manitoba and the –α3.7 deletion. Inheritance of the –α3.7 deletion has usually been reported in association with normal hematology but reduced MCV and MCH have been observed in some heterozygotes [11].