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Question answered:11/09/07 Warning! this question is over two years old.
eMedicine (an American eTextbook) has a chapter on macrocytosis [1], which reports:
“Macrocytosis, sometimes without associated anemia, is often evident in persons with chronic alcoholism. Although the macrocytosis of alcoholism may be secondary to poor nutrition with a resulting folate or vitamin B-12 deficiency, it is more often due to a direct toxicity of the alcohol on the marrow. The macrocytosis of alcoholism usually reverses only after months of abstinence from alcohol.”
With regard to folate, it states:
“Folate also is needed as a cofactor in the synthesis of DNA. Folate deficiency may be caused by any of the following:
- Dietary deficiency
- Increased requirements of pregnancy
- Congenital deficiency
- Sprue”
With regard to medical care it reports:
“Medical treatment depends on the etiology of the macrocytosis, the presence and severity of an anemia, and the symptoms of the patient.
- After the appropriate laboratory studies are obtained, the symptomatic anemic patient may be transfused with packed RBCs.
- If a drug is thought to be the cause of the macrocytic anemia, especially if hemolysis is occurring, discontinue administration of the offending drug.
- Patients deficient in vitamin B-12 or folate should receive replacement therapy.
- Counsel patients suspected of abusing alcohol to abstain.
- Treat malignancies, granulomatous diseases, and COPD according to standards for each.
Hospitalization may be required to treat some causes of macrocytosis, especially acute leukemias.”
GP Notebook has a chapter “assessment of isolated folate deficiency ( folic acid deficiency ) and macrocytosis with a normal haemoglobin” [2] which might be of interest, this can be viewed via the URL below.
References
1) http://www.emedicine.com/med/topic1381.htm
2) http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20030211093214665170
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