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what are the 2 types of macrocytic anaemia?

- Megaloblastic: bone marrow produced large, abnormal immature red cells
- Non-megaloblastic


what are the megaloblastic causes?

- B12 def (dec absorption, dec intake, abnormal metabolism)
- Folate def (dec intake, inc demand, dec absorption, jejunal disease, drugs)
- Drugs (methotrexate, hydroxyurea, azathioprine)


what are the non-megaloblastic causes?

- alcohol excess
- liver disease
- myelodysplasia
- multiple myeloma
- hypothyroidism
- Haemolysis (HA)
- Drugs


what are the symptoms of macrocytic anameia?

- anaemia symptoms (tiredness, lethargy, dyspnoea)
- FHx of AI disease
- PMHx GI surgery


what are the signs of macrocytic anaemia?

- anaemia: pallor, tachycardia, dyspnoea
- Pernicious anaemia: jaundice, glossitis, angular stomatitis, weight loss
- B12 def: peripheral neuropathy, ataxia, sub-acute combined degeneration of cord, optic atrophy, dementia


what investigations would you do?

- FBC: high MCV, pancytopenia
- TFTs
- B12 levels
- red cell folate
- LFTs (high BR)
- anti-parietal cells/ anti-IF antibodies
- Blood film: hypersegmented-nuclei neutrophils
- Schilling test - Pernicious anaemia (B12 only absorbed when given IF)


what is the management?

- Pernicious anaemia (IM hydroxycobalamin for life)
- Folate def (oral folic acid)