Macrocytosis Clinical Presentation

Updated: Dec 16, 2020
  • Author: Vincent E Herrin, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Presentation

History

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 B12 deficiencies [19]

  • Diarrhea or other gastrointestinal (GI) symptoms – These may be present in patients with tropical or celiac sprue; sprue may cause folate or vitamin B12 deficiencies [20]

  • Paresthesia or gait disturbances – These suggest vitamin B12 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; in addition, macrocytosis may result from poor nutritional intake in this population. [21]  An increased prevalence of depression and psychosis have been reported in patients with macrocytosis; those psychiatric disorders may share a common etiology with macrocytosis (eg, vitamin B12 deficiency). [22]

A thorough examination of the patient’s medication regimen is also crucial in the workup of macrocytosis, because a variety of medications may have an effect on the MCV. Recent acute blood loss may signal that reticulocytosis is causing the MCV increase.

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Physical Examination

The following physical findings may be noted:

  • Glossitis suggests that the macrocytosis stems from deficiency of vitamin B12, 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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