Macrocytic Anaemia

(Megaloblastic Anaemia)

Last updated 20.09.12

 

Index

 

Definition

-  Anaemia with macrocytosis

-  Macrocytosis = MCV 110-130 fl

-  Macrocytes = oval, anisopoikilocytosis + hypersegmented neutrophils

 

Causes

-  Folate deficiency anaemia

-  Most common cause

-  B12 deficiency

-  Pernicious anaemia

-  EtOH

-  Drugs: Azithioprine

 

Ix

-  FBE

-  RBC, Hb: anaemia

-  MCV: microcytic, normocytic, macrocytic

-  MCHC: hypochromic, normochromic, hyperchromic

-  Platelets: thrombocytopaenia

-  Blood film

-  Macrocytes = oval, anisopoikilocytosis

-  Hypersegmented neutrophils: >5 lobes to nucleus

 

Mx

-  +/- B12

-  IM daily

-  +/- Folate

-  Must also correct for B12 else anaemia improves but neuro S/S worsen

-  3-4/12

-  Reticulcytes should improve 2-3/7 w peak 6-7/7

-  Bone marrow should become normoblastic by 48hrs

-  Hb start to change in 1/52 then increase 10g/L per week+/-