Evaluation of clinical, biochemical and hematological parameters in macrocytic anemia

Abstract

Background: Macrocytosis is a common finding encountered in automated coulters and evaluation of clinical, biochemical and haematological parameters in macrocytic anemias will provide a clue to diagnosis. This study was done to evaluate the clinical and laboratory parameters in macrocytic anemias and their utility in differentiating megaloblastic and non-megaloblastic anemia.Methods: 100 patients presenting with macrocytosis were taken in to study. A detailed clinical history and physical examination was done in all cases. CBC, biochemical investigations, peripheral blood examination and reticulocyte count was done in all cases and Vitamin B12 and folate levels, bone marrow aspiration and bone marrow biopsy in some cases. After evaluation, a provisional diagnosis was made and patients with megaloblastic anaemia was given vitamin B12 and folic acid treatment and followed up after 2 weeks and 1 month.Results: Primary bone marrow disorders were the most common cause of macrocytosis (46%). The other causes in decreasing order of frequency were megaloblastic anaemia (38%), hemolytic anemia (6%), drug induced (5%), alcoholism and liver disease (4%) and idiopathic thrombocytopenic purpura (1%). There was a significant difference in the mean values of MCV and serum LDH between megaloblastic and non – megaloblastic macrocytosis. When serum LDH >1345.2 IU/L or MCV>121fl (criterion values of ROC curve) with reticulocyte count <2% was taken as criteria, the sensitivity was 92.1% and specificity was 93.5% for diagnosing megaloblastic anemia.Conclusions: Systematic evaluation of macrocytosis will help us to distinguish megaloblastic and non – megaloblastic macrocytosis. The blood and biochemical parameters especially CBC, RC, and serum LDH along with supporting clinical features help us in diagnosing megaloblastic anemia in a setup where vitamin and metabolite levels are difficult to obtain.