Macrocytic Anemia

CLINICAL DIAGNOSTIC MANUAL

Macrocytic anemia is characterized by the presence of larger-than-normal red blood cells (macrocytes) with reduced hemoglobin concentration. This condition can be caused by various factors that interfere with DNA synthesis, leading to the production of abnormal red blood cells.

Common causes include vitamin B12 and folate deficiencies, chronic alcoholism, use of certain drugs, and systemic diseases. Proper diagnosis and timely treatment are essential to correct the anemia and prevent long-term complications.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Vitamin B12 deficiency	Fatigue, weakness, pallor, shortness of breath, glossitis, paresthesias, neuropathy	Dietary history, neurological symptoms	Serum vitamin B12 levels, intrinsic factor and parietal cell antibodies
Folate deficiency	Fatigue, weakness, pallor, shortness of breath, glossitis	Dietary history, alcoholism, pregnancy	Serum folate levels, elevated homocysteine
Antifolate drugs	Fatigue, weakness, pallor, shortness of breath	Use of medications known to inhibit folate metabolism	Serum folate levels, medication review
Chronic alcoholism	Fatigue, weakness, pallor, shortness of breath, hepatomegaly	History of excessive alcohol consumption	Serum vitamin B12 and folate levels, liver function tests
Liver disease and hepatitis	Fatigue, weakness, pallor, shortness of breath, jaundice, hepatomegaly	History of liver disease, alcohol use	Liver function tests, abdominal ultrasound
Hypothyroidism	Fatigue, weakness, pallor, shortness of breath, weight gain, cold intolerance	Clinical symptoms of hypothyroidism	Thyroid function tests (TSH, free T4)
Hemolysis	Fatigue, weakness, pallor, jaundice, splenomegaly	History of hemolytic anemia, jaundice	Low haptoglobin, elevated LDH, elevated indirect bilirubin, Coombs test
Myelodysplasia	Fatigue, weakness, pallor, shortness of breath, recurrent infections, bleeding	History of persistent symptoms, advanced age	Bone marrow biopsy, complete blood count, cytogenetic analysis