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Unexplained macrocytosis in elderly patients

M Y Mahmoud1, M Lugon, C C Anderson

  • 1Department of Haematology, Whipps Cross Hospital, Leytonstone, London.

Age and Ageing
|July 1, 1996
PubMed
Summary

Diagnosing the cause of macrocytosis in elderly patients is challenging. Many older adults with macrocytosis may have undiagnosed myelodysplastic syndromes (MDS) or evolving MDS.

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Area of Science:

  • Geriatric Medicine
  • Hematology
  • Clinical Diagnostics

Background:

  • Macrocytosis, defined as a mean corpuscular volume (MCV) greater than 95 fL, is a common finding in elderly populations.
  • Determining the underlying etiology of macrocytosis in patients over 75 years old can be complex, often requiring invasive procedures.
  • Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell disorders characterized by ineffective hematopoiesis and increased risk of transformation to acute myeloid leukemia, often presenting with macrocytosis.

Purpose of the Study:

  • To investigate the diagnostic yield of non-invasive techniques versus bone marrow biopsy in identifying the cause of macrocytosis in patients aged 75 years and older.
  • To assess the prevalence of myelodysplastic syndromes (MDS) and potential early-stage MDS in this elderly cohort presenting with macrocytosis.

Main Methods:

  • A cohort of 124 patients aged 75 years or older with macrocytosis (MCV > 95 fL) was evaluated.
  • Initial assessment utilized non-invasive diagnostic techniques.
  • Patients without a definitive diagnosis underwent bone marrow biopsy for further investigation.

Main Results:

  • A definitive diagnosis for macrocytosis was achieved in 75 out of 124 patients (60%) using non-invasive methods.
  • Bone marrow biopsy identified myelodysplastic syndromes (MDS) in an additional six patients.
  • A significant proportion of the remaining patients exhibited morphological abnormalities suggestive of, but not fitting, recognized pathological entities, potentially indicating MDS in evolution.

Conclusions:

  • Non-invasive methods are effective in diagnosing the cause of macrocytosis in a majority of elderly patients.
  • Bone marrow biopsy remains crucial for diagnosing identifiable myelodysplastic syndromes (MDS) in a subset of patients.
  • Many elderly patients with unexplained macrocytosis may have morphological features indicative of evolving myelodysplastic syndromes (MDS).

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