Macrocytosis Treatment & Management

Updated: Dec 16, 2018
  • Author: Vincent E Herrin, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Treatment

Approach Considerations

Evaluation usually can be performed on an outpatient basis. Medical treatment depends on the etiology of the macrocytosis, the presence and severity of anemia, and the symptoms and physical findings. Hematologic and oncologic consultation should be obtained as necessary. After the appropriate laboratory studies are obtained, the symptomatic anemic patient may undergo transfusion with packed red blood cells (RBCs).

If a drug is thought to be the cause of the macrocytic anemia, especially if hemolysis is occurring, discontinue administration of the offending drug. If the patient is suspected of abusing alcohol, counsel abstention.

Patients deficient in vitamin B-12 or folate should receive replacement therapy. [24] Folate 1 mg/day may be prescribed in patients with folate deficiency. Intramuscular vitamin B-12 injections (100-1000 mcg/mo), continued indefinitely, may be prescribed.

Treat malignancies, granulomatous diseases, and chronic obstructive pulmonary disease (COPD) according to the standards appropriate for each. Hospitalization may be required to treat some causes of macrocytosis, especially acute leukemias. Outpatient follow-up depends on the cause of the macrocytosis.

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Diet

If folate or vitamin B-12 deficiency is the cause of the macrocytosis, modify the diet to include foods rich in these vitamins. Red meat is a good source of vitamin B-12, and green leafy vegetables are excellent sources of folate. Do not provide folate supplementation without vitamin B-12 replacement therapy in any patient with vitamin B-12 deficiency or with suspected vitamin B-12 deficiency; doing so may precipitate subacute combined degeneration of the spinal cord.

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