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Macrocytic Anemia: Causes, Symptoms, Treatment, And Types - Medical News Today
Macrocytic anemia causes a person to have large red blood cells that cannot carry enough oxygen throughout the body. The symptoms mimic other kinds of anemia but the treatment depends on the underlying cause.
Hemoglobin is an iron-containing protein in red blood cells that transports oxygen around the body. Deficiencies in vitamin B12 or folate often cause macrocytic anemia. People may also use the term vitamin deficiency anemia.
This article looks at the causes and symptoms of macrocytic anemia, the treatment options, and how to prevent complications.
Macrocytic anemia is a condition in which a person has abnormally large red blood cells and not enough healthy red blood cells.
Macrocytic anemia refers to a condition called macrocytosis in the context of anemia. Macrocytosis means that the bone marrow produces red blood cells that are too large. Healthcare professionals characterize anemia as a condition that develops when the blood does not produce enough healthy red blood cells.
Doctors use a unit called femtoliters to measure the size of blood cells. Usually, red blood cells are between 80–100 femtoliters (fL). Doctors consider red blood cells larger than 100 fL as macrocytic.
When the cells grow too large, there are fewer of them, and they contain less hemoglobin. This means the blood is not as oxygen-rich as it should be. Low blood oxygen can cause a range of symptoms and health problems.
Types of macrocytosis
Both of these types can occur along with anemia.
The symptoms of macrocytic anemia can depend on the underlying cause. For example, those macrocytic anemia caused by a vitamin B12 deficiency may experience:
Macrocytic anemia is only one type of anemia. All anemia types have similar symptoms, so a doctor uses blood tests to diagnose a person's specific anemia.
However, different types of anemia also have unique symptoms, so sometimes, a doctor may be able to identify the type based on symptoms alone.
Doctors use a person's symptoms, medical history, and blood tests to diagnose macrocytic anemia.
Tests that can help diagnose macrocytic anemia include:
Vitmain B12 deficiency
These deficiencies can occur if a person cannot absorb vitamins due to an underlying condition or because their diet lacks these vitamins.
Vitamin B12 is present in animal products, such as fish, meat, dairy, eggs, and poultry. For those following a vegetarian or vegan diet, vitamin B12 is present in fortified products, such as cereals and nutritional yeast.
In other cases, people may eat enough foods with B12 but are unable to absorb the vitamin due to autoimmune disorders, cancer, alcohol addiction, or inflammatory bowel disease.
Folate deficiency
Folate deficiency, or vitamin B9 deficiency, can also cause macrocytic anemia. Pregnant and nursing individuals may use more folate and are more likely to develop a deficiency.
People who do not eat enough folate-rich foods can also become deficient. Diseases that interfere with the body's ability to absorb nutrition, such as celiac disease, can lead to folate deficiency.
Other causes
Other causes of macrocytic anemia may include:
Each of these factors can make it more difficult for the body to absorb and metabolize essential nutrients.
Pregnant people must have healthy blood flow as the body's demand for red blood cells increases during pregnancy to provide enough oxygen to both itself and the fetus. However, pregnant people may develop macrocytic anemia during pregnancy as their bodies support the growth of a fetus.
During pregnancy, the body also has an increased demand for folic acid and vitamin B12. Often, a person has problems getting enough nutrients from their diet alone, leading to deficiencies in certain vitamins and minerals, including folic acid and B12, leading to macrocytic anemia.
When a person shows signs of macrocytic anemia, a doctor orders several blood tests to find the underlying cause. They may also ask questions about a person's diet, lifestyle, and other symptoms.
In most cases, oral folic acid taken at 1–5 milligrams (mg) daily resolves a folic acid deficiency. Alternatively, a doctor may recommend vitamin injections. Injecting vitamins ensures the body can absorb them even if an underlying condition, such as celiac disease, prevents vitamin absorption.
Eating more foods containing vitamin B12 may improve symptoms if a person is deficient in this vitamin because of their diet.
Other treatment options include:
Macrocytic anemia can cause serious complications without treatment. These include:
Infants born to those with a vitamin B12 deficiency may also experience developmental delays and have an increased risk of congenital defects affecting the brain and spinal cord.
A doctor can manage most cases of macrocytic anemia with vitamins. They will continue to monitor a person's B12 or folate levels and use blood tests to determine whether red blood cells have returned to their typical size.
When an underlying disease causes macrocytic anemia, a person's outlook depends on what disease causes the deficiency and its treatment.
People with anemia symptoms, a family history of anemia, or those who have or are at risk of developing a condition linked to macrocytic anemia should see a doctor to get a blood test for evaluation.
The following are answers to additional questions about macrocytic anemia.
How long does it take to correct macrocytic anemia?
Once a person receives a diagnosis and begins treatment with B12 or folate supplements, they should see their blood hemoglobin values gradually return to normal. However, some symptoms can take months to improve.
Why does the liver cause macrocytic anemia?
Macrocytic anemia can occur with liver diseases such as hepatitis. A high cholesterol deposition into the membranes that enclose red blood cells may be the cause.
Does leukemia cause macrocytic anemia?
In rare cases, leukemia may cause macrocytic anemia. A vitamin deficiency is the more likely cause. A person's doctor can do a thorough evaluation to determine the cause and the appropriate treatment.
Is macrocytic anemia serious?
Without treatment, macrocytic anemia can lead to serious complications. However, with an early diagnosis and treatment, a person's outlook is excellent.
Macrocytic anemia, or vitamin deficiency anemia, is a condition in which a person has abnormally large red blood cells, and not enough healthy red blood cells.
It usually develops due a a deficiency in vitamin B12 or folate. However, this might happen as a result of medications or underlying conditions that cause a person to have difficulty absorbing these vitamins. Alternatively, a person may not be consuming enough vitamin B12 or folate in their diet.
Although macrocytic anemia can cause serious complications, a person's outlook is excellent with prompt diagnosis and treatment.
Macrocytic Anemia: Symptoms, Types, And Treatment - Healthline
Macrocytic anemia happens when you have large red blood cells and not enough normal-sized red blood cells. It can result from a vitamin deficiency or an underlying condition like hypothyroidism.
Macrocytosis is a term used to describe red blood cells that are larger than normal. Anemia is when you have low numbers of properly functioning red blood cells in your body. Macrocytic anemia, then, is a condition in which your body has overly large red blood cells and not enough normal red blood cells.
Different types of macrocytic anemia can be classified depending on what's causing it. Most often, macrocytic anemias are caused by a lack of vitamin B-12 and folate. Macrocytic anemia can also signal an underlying condition.
You may not notice any symptoms of macrocytic anemia until you've had it for some time.
If you have several of these symptoms, make an appointment to see your doctor.
It's important to make an appointment as soon as possible if you have the following symptoms:
Macrocytic anemia can be broken into two main types: megaloblastic and nonmegaloblastic macrocytic anemias.
Megaloblastic macrocytic anemia
Most macrocytic anemias are also megaloblastic. Megaloblastic anemia is a result of errors in your red blood cell DNA production. This causes your body to make red blood cells incorrectly.
Nonmegaloblastic macrocytic anemia
Nonmegaloblastic forms of macrocytic anemia may be caused by a variety of factors. These can include:
Your doctor will ask about your medical history and lifestyle. They may also ask about your eating habits if they think that you have a type of anemia. Learning about your diet can help them find out if you are deficient in iron, folate, or any of the other B vitamins.
Blood tests
Your doctor will order blood tests to check for anemia and enlarged red blood cells. If your complete blood count indicates anemia, your doctor will do another test known as a peripheral blood smear. This test can help spot early macrocytic or microcytic changes to your red blood cells.
Additional blood tests can also help find the cause of your macrocytosis and anemia. This is important because treatment depends on the underlying cause.
While nutrient deficiencies cause most macrocytic anemias, other underlying conditions may cause the deficiencies. Your doctor will run tests to check your nutrient levels. They may also do blood tests to check for alcohol use disorder, liver disease, and hypothyroidism.
Your primary care doctor may also refer you to a hematologist. Hematologists specialize in blood disorders. They can diagnose the cause and specific type of your anemia.
Treatment for macrocytic anemia focuses on treating the cause of the condition. The first line of treatment for many people is correcting nutrient deficiencies. This can be done with supplements or foods like spinach and red meat. You may be able to take supplements that include folate and other B vitamins. You may also need vitamin B-12 injections if you don't absorb oral vitamin B-12 properly.
Foods high in vitamin B-12 include:
Foods high in folate include:
Most cases of macrocytic anemia that are caused by vitamin B-12 and folate deficiencies can be treated and cured with diet and supplements.
However, macrocytic anemias can cause long-term complications if left untreated. These complications can include permanent damage to your nervous system. Extreme vitamin B-12 deficiencies may cause long-term neurologic complications. They include peripheral neuropathy and dementia.
You can't always prevent macrocytic anemia, particularly when it's caused by underlying conditions out of your control. However, you can prevent the anemia from becoming severe in most cases. Try these tips:
For healthier red blood cellsMacrocytosis: What You Need To Know - WebMD
Macrocytosis is a condition in which your red blood cells are larger than they should be. While it isn't a condition of its own, macrocytosis is a sign that you have an underlying health condition and may lead to a severe form of anemia called macrocytic normochromic anemia.
Macrocytosis is also called megalocytosis or macrocythemia. When you complete blood tests, the size of red blood cells is reported in your complete blood count. Because macrocytosis often develops into severe anemia, called macrocytic anemia, it is important to pay attention to these blood test results.
The two specific indicators that your doctor looks at on blood test results include the mean corpuscular volume (MCV) and the mean corpuscular hemoglobin (MCH). If either level is elevated, it's a good indication that macrocytosis is present.
Macrocytic normochromic anemia develops slowly over time and may not show any symptoms until it is already severe. Common symptoms include:
Macrocytosis isn't a disease itself but is instead a condition that results from other underlying health problems that include:
Macrocytosis may also be the side effect of some medications prescribed to treat cancer, seizures, or autoimmune disorders. If you lose a lot of blood because of an accident or injury, your bone marrow may produce more red blood cells to address the problem. Bone marrow cancer, also called myelodysplastic syndrome, may also lead to macrocytosis.
Blood work to test for macrocytosis should include:
Following a blood test, your doctor may want to assess the severity of your anemia. Your doctor will assess your health history to determine the likelihood of macrocytic anemia. A diagnosis is usually made based on the peripheral smear, with other results also contributing.
The smear provides imagery of your red blood cells' shape and size for examination. Macrocytosis doesn't necessarily mean you have an iron deficiency. When macrocytosis is fully developed, your MCV levels are 100 fluid liters per cell if you don't also have an iron deficiency, thalassemia trait, or kidney disease. Other indicators include:
Keep in mind that if you do have an iron deficiency, macrocytosis may be overlooked. However, the presence of Howell-Jolly bodies and granulocyte hypersegmentation are red flags of macrocytic normochromic anemia.
If you have a B12 or folate deficiency, your doctor completes additional testing to determine the cause of your deficiencies. By addressing the underlying cause, you can increase your vitamin levels and improve your macrocytosis.
Management of macrocytosis consists of finding and treating the underlying cause. In the case of vitamin B-12 or folate deficiency, treatment may include diet modification and dietary supplements or injections. If the underlying cause is resulting in severe anemia, you might need a blood transfusion.
Addressing a vitamin B12 deficiency. If you're not getting enough vitamin B12 or folate in your diet, eat foods rich in these nutrients. If you're still not getting enough, you may need to take supplements.
If you are 14 or older, you need to get 2.4 micrograms of vitamin B12 every day. If you are pregnant or breastfeeding, you need slightly more. In this case, aim for between 2.6 and 2.8 micrograms each day.
There is no upper limit set for vitamin B12, meaning that too much isn't toxic for you. However, some studies show that taking in 25 or more micrograms per day increases your risk for bone fracture.
Foods rich in vitamin B12 include:
Addressing a vitamin folate deficiency. If you are 19 years or older, you need 400 micrograms of dietary folate equivalents (DFE) each day. If you are pregnant, you need 600 micrograms each day, and if you are breastfeeding, you need 500 micrograms each day.
If you drink alcohol regularly, you should also try to get 600 micrograms of folate. High levels of alcohol consumption may impair your body's ability to absorb folate. Try not to take more than 1,000 micrograms per day of folate in the form of a supplement. When you get folate from food, there is no limit placed on how much you can eat. Foods rich in folate or dietary folate equivalents include:
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