Macrocytosis Clinical Presentation
- Author: Vincent E Herrin, MD, FACP; Chief Editor: Emmanuel C Besa, MD more...
The symptoms of macrocytosis are attributable either to the anemia itself or to the underlying condition causing the anemia. They may include the following:
- Dyspnea – This is a consequence of anemia; in acute or severe anemia, the volume of hemoglobin in the blood is inadequate to provide appropriate oxygenation of the tissues
- Headache – This is a symptom of anemia due to decreased oxygenation of the tissues
- Fatigue – This may be attributed to underlying disease, if present, or to inadequate blood volume
- Sore tongue – This may reflect glossitis or atrophy of the tongue, which are common findings in folate and vitamin B-12 deficiencies
- Diarrhea or other gastrointestinal (GI) symptoms – These may be present in patients with tropical or celiac sprue; sprue may cause folate or vitamin B-12 deficiencies
- Paresthesia or gait disturbances – These suggest vitamin B-12 deficiency
A history of alcohol abuse may be an important clue to the cause of the increased mean cell volume (MCV); long-term use of alcohol may have a direct toxic effect on the bone marrow, causing macrocytosis. A thorough examination of the patient’s medication regimen is also crucial in the workup of macrocytosis; a variety of medications may have an effect on the MCV. Recent acute blood loss may signal that reticulocytosis is causing the MCV increase.
The following physical findings may be noted:
- Glossitis suggests that the macrocytosis stems from deficiency of vitamin B-12, folate, or both
- Tachycardia is usually modest and is common in patients with severe anemia
- Flow murmurs usually are noted only in patients with severe anemia
- Splenomegaly may be quite remarkable when the macrocytosis is due to hemolysis, infiltrative disorders, or neoplasms
- Jaundice suggests liver disease or hemolysis, both of which may lead to an increased MCV
- Conjunctival pallor is evident in patients with severe anemia
- Neurologic disorders, such as ataxia, loss of posterior column sensations, loss of deep tendon reflexes (particularly ankle reflex), and confabulation, may suggest thiamine deficiency
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