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Macrocytic Anemia. Clinical pathology department SCU. Normal blood cells . Complete Blood Count (CBC). Normal red blood cells. Definition. An ( without ) - emia ( blood ): a reduction below normal in hemoglobin or red blood cell number. Symptoms and signs of Anemia.

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Macrocytic Anemia

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Macrocytic Anemia

Clinical pathology department

SCU


Normal blood cells


Complete Blood Count (CBC)

Normal red blood cells


Definition

An (without) -emia (blood):

a reduction below normal

in hemoglobin or red blood cell number


Symptoms and signs of Anemia

  • None if mild

  • Fatigue

  • Breathlessness

  • Dizzines

  • Pale Skin & mucous membranes

  • Jaundice ( if hemolytic)

  • Tachycardia


Differential Diagnosis Using MCV

  • Macrocytic anemias (MCV = 150 fl): > normal cells

  • Normocytic (MCV = 80-96 fl): cells are normal in volume

  • Microcytic anemias (MCV = 50 fl): cells are < normal


Macrocytic anemia

  • Defined as MCV > 100 femtoliters

  • Identified by peripheral blood smear or automated RBC indices

    • Smear is more sensitive in detecting early macrocytic changes and small numbers of macrocytes

    • Cell morphology can aid in determining etiology of macrocytosis


Common Causes of Macrocytosis


Megaloblastic Anemia

  • Defective DNA synthesis leads to nuclear/cytoplasmic asynchrony

  • B12/folate deficiency

  • Macrocytic anemia with hypersegmented neutrophils


Megaloblastic Anemia

  • retardedDNA synthesis

  • unimpaired RNA synthesis

  • BIG cells!

  • immature nucleus

  • maturecytoplasm


How is B12 involved?

  • B12 (and folate) are required for DNA synthesis.

    • Slowed DNA synthesis means big, immature nucleus

    • Cytoplasm (with RNA in it) matures just fine

  • B12 is also required for conversion of homocysteine to methionine

    • ↑ homocysteine = atherosclerosis!

    • ↓ methionine = subacute combined degeneration


Megaloblastic anemia


Megaloblastic anemia


Reticulocyte Count (In the Diagnosis of Anemia)

  • Useful in determining response and potential of bone marrow.

  • Reticulocytes are non-nucleated RBCs that still contain RNA.

  • Visualized by staining with supravital dyes, including new methylene blue or brilliant cresyl blue; RNA is precipitated as dye-protein complex.

  • Normal range is 0.5-2.0% of all erythrocytes.

  • If bone marrow responding to anemia, should see increases in retic count.

  • Newborns have higher retic count than adults until second or third week of life.


Retics Slide


Thank You


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