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Anemia (Macrocytic)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Low blood oxygen levels can lead to fatigue, pallor, shortness of breath, weakness, diarrhea, anorexia, glossitis, instability when walking, tingling in the hands or feet, and confusion. The two most common causes of megaloblastic anemia are deficiencies of vitamin B12 or folate (vitamin B9). Other causes of macrocytosis include liver disease (alcohol-related), drugs (chemotherapy compounds, anticonvulsants, antibiotics, and HIV medications), bone marrow disorders, hypothyroidism, hemolysis, and pregnancy. Treatment is directed to the underlying cause.1
Case 7
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
The causes are varied, but a raised MCV may be associated with chronic alcohol excess, which can have a direct impact on bone marrow function leading to an overall macrocytosis. Important causes of macrocytosis include B12 or folate deficiency, reticulocytosis and hypothyroidism.
Nutritional Deficiencies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Deepa Bhupali, Fernando D. Testai
Hematologic workup: May be normal.Anemia or pancytopenia.Macrocytosis.Neutrophil hypersegmentation (may be present even in the absence other hematologic abnormalities).
Vitamin B12 deficiency in Indian infants and children
Published in Paediatrics and International Child Health, 2020
Nutritional vitamin B12 deficiency (NVBD) in Indian infants has been described for more than 60 years. In 1957, a case series of 25 infants was reported with a constellation of symptoms and signs characterised by pallor, skin hyperpigmentation and regression of neurodevelopment [1]. These infants were exclusively breastfed by strictly vegetarian mothers from a poor socio-economic background. Although they looked plump, the infants had other signs of malnutrition. Moderate-to-severe anaemia with a tendency to macrocytosis was detected in all of them. Bone marrow examination in one case demonstrated megaloblastic change. The infants were treated with liver extract alone or in combination with B complex factor or B12. The response was uniformly good in all cases and was seen as early as the third or fourth day. The author called this condition ‘nutritional dystrophy with anaemia’ and it was speculated that vitamin B12 deficiency was the underlying cause. Jadhav and co-authors in 1962 [2] and Srikantia and Reddy in 1967 [3] confirmed a causal relationship between the clinical presentation and vitamin B12 deficiency by means of appropriate laboratory evidence of vitamin B12 deficiency (macrocytosis, megaloblastic bone marrow) and observing a good therapeutic response to vitamin B12 supplementation. These authors found that the mothers of affected infants were also vitamin B12-deficient as they had low levels of vitamin B12 in their serum and breast-milk [2,3].
How I approach new onset thrombocytopenia
Published in Platelets, 2020
Alcohol can cause myelotoxicity in the absence of apparent toxicity to other organs. Thrombocytopenia can be seen in 3–43% of alcoholics in the community and 14–81% of hospitalized alcoholics. The platelet count can be expected to rise after 2–5 days of abstinence and generally returns to the normal range within one week. Often rebound to higher than normal levels is seen, unless other contributors such as splenomegaly (sequestration) or cirrhosis (decreased thrombopoietin production) are present [23]. Macrocytosis is usually seen, and this persists for 2–4 months after abstinence and is the most reliable pointer to potential alcoholic etiology [24].
ZRSR2 mutation in a child with refractory macrocytic anemia and Down Syndrome
Published in Pediatric Hematology and Oncology, 2019
Meghna Srinath, Emily Coberly, Kimberly Ebersol, Kirstin Binz, Katsiaryna Laziuk, William T. Gunning, Barbara Gruner, Richard Hammer, Bindu Kanathezhath Sathi
Individuals with Down syndrome (DS) are frequently found to have neutropenia and macrocytosis without anemia1,2 and the etiology remains unclear. Macrocytosis appears to be independent of serum vitamin B12 and folate status, fetal hemoglobin (Hb) concentration and hypothyroidism in most cases.2,3