what is macrocytic anemia?
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Macrocytic anemia in the elderly is often megaloblastic because of vitamin B12 or folate deficiency. Macrocytic anemia may also be caused by hypothyroidism, chronic liver disease, or hemolytic anemia as well as by certain drugs (ie, chemotherapeutic drugs and anticonvulsants).
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This article discusses the medical condition. For the fern genus, see Anemia (fern)Anemia or anaemia (see spelling differences), which literally means "without blood," is a deficiency of red blood cells and/or hemoglobin. This results in a reduced ability of blood to transfer oxygen to the tissues, and this causes hypoxia; since all human cells depend on oxygen for survival, varying degrees of anemia can have a wide range of clinical consequences. Hemoglobin (the oxygen-carrying protein in the red blood cells) has to be present to ensure adequate oxygenation of all body tissues and organs.
The three main classes of anemia include excessive blood loss (acutely such as a hemorrhage or chronically through low-volume loss), excessive red blood cell destruction (hemolysis) or deficient red blood cell production. In menstruating women, dietary iron deficiency is a common cause of deficient red blood cell production.
Anemia is the most common disorder of the blood. There are several kinds of anemia, produced by a variety of underlying causes. Anemia can be classified in a variety of ways, based on the morphology of RBCs, underlying etiologic mechanisms, discernible clinical spectra, to mention a few.
Different clinicians approach anemia in different ways; two major approaches of classifying anemias include the "kinetic" approach which involves evaluating production, destruction and loss, and the "morphologic" approach which groups anemia by red blood cell size. (Schier) The morphologic approach uses a quickly available and cheap lab test as its starting point (the MCV--see below). On the other hand, focusing early on the question of production (e.g., via the reticulocyte count) may allow the clinician to more rapidly expose cases where multiple causes of anemia may coexist. Regardless of one's philosophy about the classification of anemia, however, methodical clinical evaluation should yield equally good results.
In microcytic anemias the RBCs appear smaller than normal when viewed on a peripheral blood smear and the mean cell volume (MCV), a measure of red cell size, is generally less than 80 femtoliters (fL) (normal: about 90 fL). A microcytic anemia can be the result of insufficient iron supplies or defective hemoglobin synthesis. Iron is critical for oxygen transport in the body. Iron deficiency may result from inadequate dietary intake, loss through bleeding, or an increased need for iron such as occurs in pregnant women and growing children. Defective hemoglobin synthesis may cause a variety of anemias that range from mild to severe. Hemoglobin, with its four globin chains, is a tetramer, that is, a molecule composed of four subunits. When variations occur, either in the type of globin chain in the tetramer or in the makeup of the individual chains, the result is a hemoglobinopathy (thalassemia syndrome). Many thalassemias, particularly those with variations in the content of the individual chains, present as microcytic anemias.
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