Pearl of the Month

What is causing my patients’ macrocytosis?

Publish date: June 5, 2018

 


Dr. Seppä and colleagues also reported on hematologic morphologic features in nonanemic patients with macrocytosis due to alcohol abuse or vitamin B12 deficiency.4 They studied 136 patients with alcohol abuse and normal B12 levels, and 18 patients with pernicious anemia. The combination of a low red cell count or a high red cell distribution width with a normal platelet count was found in 94.4% of the vitamin-deficient patients but in only 14.6% of the abusers.

Dr. Douglas S. Paauw, professor of medicine in the division of general internal medicine at the University of Washington, Seattle

Dr. Douglas S. Paauw

Patients with unexplained macrocytosis should be followed for the development of a primary bone marrow disorder. Dr. Mohamad Younes and colleagues followed 43 patients with unexplained macrocytosis, and found that 11.6% developed a primary bone marrow disorder, and 16% developed worsening cytopenia, over 4 years.5 This is especially important to consider in older patients, among whom myelodysplastic syndromes are more common.

Pearl: Strongly consider alcohol as the cause of the incidental finding of macrocytosis, especially in patients without anemia.

Dr. Paauw is professor of medicine in the division of general internal medicine at the University of Washington, Seattle, and he serves as third-year medical student clerkship director at the university. Contact Dr. Paauw at dpaauw@uw.edu.

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