Macrocytosis in alcohol-related liver disease: its value for screening

The incidence of macrocytosis, defined as a mean corpuscular volume (MCV) of greater than 95 fl and large red cells on peripheral blood film, was determined in 303 alcoholics with liver disease (95 females: 208 males), 60 non-alcoholics with chronic liver disease (44 females: 16 males) and 35 control subjects (15 females: 20 males). Macrocytosis was found in 70.3% (213/303) of alcoholics with liver disease and in 23.3% (14/60) of non-alcoholics with liver disease, P less than 0.001. MCV values greater than 100 fl were seen in 49.5% (150/303) of alcoholics, but in only 3.3% (2/60) of non-alcoholics, P less than 0.001. Macrocytosis was more frequent in female, 86.3% (82/95) than in male alcoholics 63.0% (131/208), P less than 0.001. Serum folate values less than 3 microgram/l were found in 14.5% (44/303) of alcoholics and in 11.7% (7/60) of non-alcoholics. Low serum folate values were found in 18.3% (39/213) of alcoholics with macrocytosis and in 35.9% (28/78) of those with macrocytic anaemia. Twenty alcoholics with pre-cirrhotic liver disease were followed over three months. Macrocytosis was present in 85.0% (17/20) at the outset and in 40% (8/20) 3 months later. The changes in MCV were independent of alcohol intake and serum folate values. Macrocytosis is a useful diagnostic indicator of alcoholism. MCV values greater than 100 fl in patients with liver disease almost invariably indicate alcohol-related disease. In the short-term, changes in MCV are of little use in monitoring alcohol intake.