CLINICAL DIAGNOSTIC MANUAL
Macrocytic anemia is characterized by the presence of larger-than-normal red blood cells (macrocytes) with reduced hemoglobin concentration. This condition can be caused by various factors that interfere with DNA synthesis, leading to the production of abnormal red blood cells.
Common causes include vitamin B12 and folate deficiencies, chronic alcoholism, use of certain drugs, and systemic diseases. Proper diagnosis and timely treatment are essential to correct the anemia and prevent long-term complications.
Pathology | Clinical Symptoms and Signs | Suspected Diagnosis | Confirmatory Diagnosis |
|---|---|---|---|
Vitamin B12 deficiency | Fatigue, weakness, pallor, shortness of breath, glossitis, paresthesias, neuropathy | Dietary history, neurological symptoms | Serum vitamin B12 levels, intrinsic factor and parietal cell antibodies |
Folate deficiency | Fatigue, weakness, pallor, shortness of breath, glossitis | Dietary history, alcoholism, pregnancy | Serum folate levels, elevated homocysteine |
Antifolate drugs | Fatigue, weakness, pallor, shortness of breath | Use of medications known to inhibit folate metabolism | Serum folate levels, medication review |
Chronic alcoholism | Fatigue, weakness, pallor, shortness of breath, hepatomegaly | History of excessive alcohol consumption | Serum vitamin B12 and folate levels, liver function tests |
Liver disease and hepatitis | Fatigue, weakness, pallor, shortness of breath, jaundice, hepatomegaly | History of liver disease, alcohol use | Liver function tests, abdominal ultrasound |
Hypothyroidism | Fatigue, weakness, pallor, shortness of breath, weight gain, cold intolerance | Clinical symptoms of hypothyroidism | Thyroid function tests (TSH, free T4) |
Hemolysis | Fatigue, weakness, pallor, jaundice, splenomegaly | History of hemolytic anemia, jaundice | Low haptoglobin, elevated LDH, elevated indirect bilirubin, Coombs test |
Myelodysplasia | Fatigue, weakness, pallor, shortness of breath, recurrent infections, bleeding | History of persistent symptoms, advanced age | Bone marrow biopsy, complete blood count, cytogenetic analysis |
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