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Etiology and diagnostic evaluation of macrocytosis.
Am J Med Sci. 2000 Jun; 319(6):343-52.AJ

Abstract

BACKGROUND

Elevation of mean cell volume (MCV) is a common clinical problem, but the etiologic spectrum and optimal diagnostic evaluation of macrocytosis are not well defined.

METHODS

We studied 300 consecutive hospitalized adult patients with MCV values > or = 100 fL. Assessment included complete blood counts, morphologic review, liver function tests, and levels of serum cobalamin (Cbl), methylmalonic acid, and total homocysteine.

RESULTS

The most common cause of macrocytosis was drug therapy, followed by alcohol, liver disease, and reticulocytosis. Megaloblastic hematopoiesis accounted for less than 10% of cases. MCV values > 120 fL were usually caused by Cbl deficiency. Anisocytosis, macro-ovalocytosis, and teardrop erythrocytes were most prominent in megaloblastic hematopoiesis. Elevated levels of serum methylmalonic acid and total homocysteine were useful in the diagnosis of Cbl deficiency.

CONCLUSIONS

Drugs and alcohol are the most common causes of macrocytosis in hospitalized patients in a New York City teaching hospital. We have formulated tentative guidelines for the evaluation of high MCV values in this setting.

Authors+Show Affiliations

Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York, USA. savage@cuccfa.ccc.columbia.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10875288

Citation

Savage, D G., et al. "Etiology and Diagnostic Evaluation of Macrocytosis." The American Journal of the Medical Sciences, vol. 319, no. 6, 2000, pp. 343-52.
Savage DG, Ogundipe A, Allen RH, et al. Etiology and diagnostic evaluation of macrocytosis. Am J Med Sci. 2000;319(6):343-52.
Savage, D. G., Ogundipe, A., Allen, R. H., Stabler, S. P., & Lindenbaum, J. (2000). Etiology and diagnostic evaluation of macrocytosis. The American Journal of the Medical Sciences, 319(6), 343-52.
Savage DG, et al. Etiology and Diagnostic Evaluation of Macrocytosis. Am J Med Sci. 2000;319(6):343-52. PubMed PMID: 10875288.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Etiology and diagnostic evaluation of macrocytosis. AU - Savage,D G, AU - Ogundipe,A, AU - Allen,R H, AU - Stabler,S P, AU - Lindenbaum,J, PY - 2000/6/30/pubmed PY - 2000/7/15/medline PY - 2000/6/30/entrez SP - 343 EP - 52 JF - The American journal of the medical sciences JO - Am J Med Sci VL - 319 IS - 6 N2 - BACKGROUND: Elevation of mean cell volume (MCV) is a common clinical problem, but the etiologic spectrum and optimal diagnostic evaluation of macrocytosis are not well defined. METHODS: We studied 300 consecutive hospitalized adult patients with MCV values > or = 100 fL. Assessment included complete blood counts, morphologic review, liver function tests, and levels of serum cobalamin (Cbl), methylmalonic acid, and total homocysteine. RESULTS: The most common cause of macrocytosis was drug therapy, followed by alcohol, liver disease, and reticulocytosis. Megaloblastic hematopoiesis accounted for less than 10% of cases. MCV values > 120 fL were usually caused by Cbl deficiency. Anisocytosis, macro-ovalocytosis, and teardrop erythrocytes were most prominent in megaloblastic hematopoiesis. Elevated levels of serum methylmalonic acid and total homocysteine were useful in the diagnosis of Cbl deficiency. CONCLUSIONS: Drugs and alcohol are the most common causes of macrocytosis in hospitalized patients in a New York City teaching hospital. We have formulated tentative guidelines for the evaluation of high MCV values in this setting. SN - 0002-9629 UR - https://www.unboundmedicine.com/medline/citation/10875288/Etiology_and_diagnostic_evaluation_of_macrocytosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9629(15)40772-4 DB - PRIME DP - Unbound Medicine ER -