Macrocytes

Morphological evidence of any accompanying disease should actively be sought. Most frequently these causes are B12 or folate deficiency, myelodysplasia, or liver disease.

https://haematologyetc.co.uk/index.php?title=Macrocytic_Red_Cells

Impaired cell division (nutritional or metabolic)

  1. Vitamin B12 deficiency (most commonly due to impaired absorption)
  2. Folic acid deficiency (most commonly dietary deficiency)
 

Impaired cell division (drug)

  1. Cytotoxic e.g. hydroxycarbamide
  2. Immunosuppressive e.g. azathioprine
 

Defective cell formation

  1. Most frequently myelodysplasia (also seen in congenital dyserythropoiesis, aplastic anaemia or post stem-cell transplant)
 

Other causes

  1. Alcohol and liver disease: excess cell membrane lipid
  2. Hypothyroidism. Likely caused by reduced cell division
  3. Drugs and medication, causing macrocytosis through various mechanisms
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