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A systematic approach to macrocytosis. Sorting out the causes

¹Island Medical Laboratories, Victoria, BC, Canada.

Postgraduate Medicine

|May 1, 1995

Summary

Physicians often encounter unexplained macrocytosis. Initial evaluation involves history, physical exam, and blood tests to systematically identify causes like alcoholism or myelodysplasia before specific nutrient testing.

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Area of Science:

Hematology
Clinical Medicine
Diagnostic Evaluation

Background:

Multiparameter hematology instruments are widely used.
Physicians frequently encounter patients with macrocytosis of unknown etiology.
Common causes like alcoholism, liver disease, drugs, and myelodysplasia must be considered.

Observation:

Macrocytosis without an obvious cause presents a diagnostic challenge.
Folate and vitamin B12 deficiencies may be less common causes depending on patient demographics.
Initial diagnostic steps are crucial for systematic evaluation.

Findings:

A thorough history and physical examination are essential.
Complete hematologic profile, reticulocyte count, and peripheral blood smear are key initial tests.
These initial evaluations guide further investigations.

Implications:

Systematic approach aids in identifying the underlying cause of macrocytosis.
Targeted testing for serum B12 and red cell folate can be performed as needed.
Efficient diagnostic pathways improve patient management for macrocytosis.

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