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Prevalence of potential underlying aetiology of macrocytic anaemia in Dutch general practice.
BMC Fam Pract 2016; 17(1):113BF

Abstract

BACKGROUND

Macrocytic anaemia (MCV ≥ 100 fL) is a relatively common finding in general practice. However, literature on the prevalence of the different causes in this population is limited. The prevalence of macrocytic anaemia and its underlying aetiology were analysed in a general practice population. The potential effect of the different aetiology on survival was also evaluated.

METHODS

Between the 1st of February 2007 and the 1st of February 2015, patients aged 50 years or older and presenting to their general practitioner with a newly diagnosed anaemia, were included in the study. Anaemia was defined as haemoglobin level below 13.7 g/dL in men and below 12.1 g/dL in women. A broad range of laboratory tests was performed for each patient. The causes of anaemia were consequently determined by two independent observers based on the laboratory results.

RESULTS

Of the 3324 included patients, 249 (7.5 %) displayed a macrocytic anaemia and were subsequently analysed. An underlying explanation could be established in 204 patients (81.9 %) with 27 patients (13.2 %) displaying multiple causes. Classic aetiology (i.e. alcohol abuse, vitamin B12/folic acid deficiency, haemolysis and possible bone marrow disease) was found in 115 patients. Alternative causes (i.e. anaemia of chronic disease, iron deficiency, renal anaemia and other causes) were encountered in 101 patients. In addition, a notable finding was the median gamma GT of 277 U/L in patients diagnosed with alcohol abuse (N = 24, IQR 118.0-925.5) and 23 U/L in the remaining cohort (N = 138, IQR 14.0-61.0). The distribution of gamma GT values was statistically different (P < 0.001). Five year survival rates were determined for six categories of causes, ranging from 39.9 % (95 % CI 12.9-66.9) for renal anaemia to 76.2 % (95 % CI 49.4-103.0) for the category multiple causes.

CONCLUSION

In addition to classic explanations for macrocytosis, alternative causes are frequently encountered in patients with macrocytic anaemia in general practice.

Authors+Show Affiliations

Department of Clinical Chemistry, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, room F3126, 3300, AK, Dordrecht, The Netherlands. k.stouten@asz.nl. Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3300, AK, Dordrecht, The Netherlands. k.stouten@asz.nl.Department of Clinical Chemistry, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, room F3126, 3300, AK, Dordrecht, The Netherlands.Department of Haematology, St Elisabeth Hospital, Hilvarenbeekse Weg 60, 5022, GC, Tilburg, The Netherlands.Department of Clinical Chemistry, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, room F3126, 3300, AK, Dordrecht, The Netherlands. Department of Clinical Chemistry, Admiraal de Ruyter Hospital, 's-Gravenpolderseweg 114, 4462, RA, Goes, The Netherlands.Department of Biostatistics, Erasmus Medical Centre, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands.General practitioner at General Medical Practice van Houten, Tromplaan 49, 3342 TR, H.I., Ambacht, The Netherlands.Department of Clinical Chemistry, Beatrix Hospital, Banneweg 57, 4204, AA, Gorinchem, The Netherlands.Department of Haematology, Erasmus Medical Centre, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands.Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3300, AK, Dordrecht, The Netherlands.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27542607

Citation

Stouten, Karlijn, et al. "Prevalence of Potential Underlying Aetiology of Macrocytic Anaemia in Dutch General Practice." BMC Family Practice, vol. 17, no. 1, 2016, p. 113.
Stouten K, Riedl JA, Droogendijk J, et al. Prevalence of potential underlying aetiology of macrocytic anaemia in Dutch general practice. BMC Fam Pract. 2016;17(1):113.
Stouten, K., Riedl, J. A., Droogendijk, J., Castel, R., van Rosmalen, J., van Houten, R. J., ... Levin, M. D. (2016). Prevalence of potential underlying aetiology of macrocytic anaemia in Dutch general practice. BMC Family Practice, 17(1), p. 113. doi:10.1186/s12875-016-0514-z.
Stouten K, et al. Prevalence of Potential Underlying Aetiology of Macrocytic Anaemia in Dutch General Practice. BMC Fam Pract. 2016 08 19;17(1):113. PubMed PMID: 27542607.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of potential underlying aetiology of macrocytic anaemia in Dutch general practice. AU - Stouten,Karlijn, AU - Riedl,Jurgen A, AU - Droogendijk,Jolanda, AU - Castel,Rob, AU - van Rosmalen,Joost, AU - van Houten,Ron J, AU - Berendes,Paul, AU - Sonneveld,Pieter, AU - Levin,Mark-David, Y1 - 2016/08/19/ PY - 2016/05/03/received PY - 2016/08/16/accepted PY - 2016/8/21/entrez PY - 2016/8/21/pubmed PY - 2017/11/8/medline KW - Erythrocytes KW - Erythropoiesis KW - General practice KW - Laboratory markers KW - Macrocytic anaemia KW - Survival SP - 113 EP - 113 JF - BMC family practice JO - BMC Fam Pract VL - 17 IS - 1 N2 - BACKGROUND: Macrocytic anaemia (MCV ≥ 100 fL) is a relatively common finding in general practice. However, literature on the prevalence of the different causes in this population is limited. The prevalence of macrocytic anaemia and its underlying aetiology were analysed in a general practice population. The potential effect of the different aetiology on survival was also evaluated. METHODS: Between the 1st of February 2007 and the 1st of February 2015, patients aged 50 years or older and presenting to their general practitioner with a newly diagnosed anaemia, were included in the study. Anaemia was defined as haemoglobin level below 13.7 g/dL in men and below 12.1 g/dL in women. A broad range of laboratory tests was performed for each patient. The causes of anaemia were consequently determined by two independent observers based on the laboratory results. RESULTS: Of the 3324 included patients, 249 (7.5 %) displayed a macrocytic anaemia and were subsequently analysed. An underlying explanation could be established in 204 patients (81.9 %) with 27 patients (13.2 %) displaying multiple causes. Classic aetiology (i.e. alcohol abuse, vitamin B12/folic acid deficiency, haemolysis and possible bone marrow disease) was found in 115 patients. Alternative causes (i.e. anaemia of chronic disease, iron deficiency, renal anaemia and other causes) were encountered in 101 patients. In addition, a notable finding was the median gamma GT of 277 U/L in patients diagnosed with alcohol abuse (N = 24, IQR 118.0-925.5) and 23 U/L in the remaining cohort (N = 138, IQR 14.0-61.0). The distribution of gamma GT values was statistically different (P < 0.001). Five year survival rates were determined for six categories of causes, ranging from 39.9 % (95 % CI 12.9-66.9) for renal anaemia to 76.2 % (95 % CI 49.4-103.0) for the category multiple causes. CONCLUSION: In addition to classic explanations for macrocytosis, alternative causes are frequently encountered in patients with macrocytic anaemia in general practice. SN - 1471-2296 UR - https://www.unboundmedicine.com/medline/citation/27542607/Prevalence_of_potential_underlying_aetiology_of_macrocytic_anaemia_in_Dutch_general_practice_ L2 - https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-016-0514-z DB - PRIME DP - Unbound Medicine ER -