Diagnosis of megaloblastic anaemias

Wickramasinghe, S. N.

doi:10.1016/j.blre.2006.02.002

Cited by 140 publications

(98 citation statements)

References 98 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Schistocytes, thrombocytopenia, and chemical indicators of hemolysis could even lead to an erroneous diagnosis of microangiopathic hemolytic anemia. Red cell fragmentation and marked abnormality in size and shape in severe megaloblastic anemia were noted in a recent review [4] but may not be widely recognized by generalists.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Life-threatening megaloblastic pancytopenia with normal mean cell volume: Case series

Sekhar

Stabler

2007

European Journal of Internal Medicine

View full text Add to dashboard Cite

The mean red blood cell volume (MCV) is usually increased in severe megaloblastic anemia due to pernicious anemia. However, during one year in a university hospital, three patients with lifethreatening pancytopenia and normal MCV were proven to have severe vitamin B12 deficiency. The red blood cell distribution width was markedly increased (three times normal) and led to review of the blood smear and recognition of megaloblastosis as well as prominent red cell fragmentation. These three cases illustrate that vitamin B12 status should be evaluated in cases of pancytopenia, independent of the MCV value.

show abstract

Section: Discussionmentioning

confidence: 98%

“…Thalassemia, or iron deficiency, can also mask macrocytosis [1][2][3][4]. However, case 3 demonstrated an increase in hematocrit to 49% with a MCV of 83 fL after B12 treatment alone, suggesting that he was iron-replete.…”

Section: Discussionmentioning

confidence: 99%

Life-threatening megaloblastic pancytopenia with normal mean cell volume: Case series

Sekhar

Stabler

2007

European Journal of Internal Medicine

View full text Add to dashboard Cite

show abstract

“…Once cobalamin deficiency has been documented, the first step towards aetiological diagnosis is to rule out insufficient nutritional cobalamin intake or intestinal malabsorption by taking a thorough food anamnesis and searching for other clinical or biological signs of malnutrition or malabsorption [2,4]. The next step aims to eliminate pernicious anaemia [24], the main differential diagnosis of FCM, by searching for anti-intrinsic factor antibodies and anti-gastric parietal cell antibodies and performing a gastroscopy with systematic biopsies so as to detect auto-immune atrophic funditis [25]. It's important to note that this "deductive elimination" FCM diagnosis process has not been validated in an evidence based medicine approach but may be of interest in routine.…”

Section: Positive and Aetiological Diagnosismentioning

confidence: 99%

The Syndrome of Food-Cobalamin Malabsorption: A Personal View in a Perspective of Clinical Practice

Serraj¹

2011

J Blood Disord Transfus

View full text Add to dashboard Cite

SummaryThis article presents recent findings on cobalamin deficiencies due to food-cobalamin malabsorption or nondissociation of vitamin B12 from its carrier proteins syndrome. These findings might be of interest to medical practitioners. This disorder, for which a definitive consensus on the criteria for diagnosis is not yet available, is the leading cause of cobalamin deficiency in the elderly. In practice, food-cobalamin malabsorption is a diagnosis of exclusion, and requires the deductive elimination of all other causes of cobalamin deficiencies, particularly pernicious anaemia. The causes or associated disorders of food-cobalamin malabsorption are multiple and include gastric pathologies, Helicobacter pylori infections and certain drugs (biguanides and proton pump inhibitors). Depending on the disease aetiology, treatment of food-cobalamin malabsorption involves oral supplementation of doses lower than those required for pernicious anaemia.

show abstract

“…Patients with vitamin B12 and/or folate deficiency present with macrocytic anaemia, however, haematological findings are a late sign of deficiency. 1,2 Patients may present with isolated macrocytosis without anaemia, with normocytic anaemia without macrocytosis, or with the absence of both macrocytosis and anaemia, 3 and in these cases it is necessary to determine whether deficiencies are appropriately investigated. Vitamin B12 and folate Vitamin B12 has important roles in nucleic acid synthesis and myelin production in the nervous system.…”

Section: Introductionmentioning

confidence: 99%

Are we appropriately testing for vitamin B12 and folate deficiency?

Davids

Hoffmann

Naidoo

et al. 2018

Ann. Clin. Chem. & Lab. Med.

View full text Add to dashboard Cite

BACKGROUNDThe most common reason for assessing vitamin B12 and folate status is a clinical suspicion of deficiency along with the haematological abnormality of macrocytic anaemia. However, there is often a lack of a precise clinical or haematological picture to guide the appropriate investigation of these patients. Normal haemoglobin or mean cell volumes are often found, masking the need for appropriate investigation. When abnormal haematological parameters are found, it is often a sign of advanced deficiency. In this study we investigated whether patients with haematological findings of macrocytosis and/or anaemia are appropriately investigated for vitamin B12 and folate deficiencies and whether clinicians request metabolite screening to assist with the diagnosis. METHODS This was a retrospective audit of data obtained from the laboratory information system for a six month period at a tertiary academic hospital. Adult patients with macrocytosis, anaemia or both were selected and laboratory records reviewed to determine whether they were investigated for vitamin B12 and folate deficiency. RESULTS Only 16.2% of patients with macrocytic anaemia, 7.8% of patients with isolated macrocytosis and 6.5% of patients with normocytic anaemia were tested for vitamin B12 and/or folate deficiency. Metabolite assays such as homocysteine and methylmalonic acid were not requested as part of a vitamin status assessment. CONCLUSION In our setting, vitamin B12 and folate assessment is a diagnostic dilemma, delaying identification of potentially debilitating disease. Clinicians need to be informed about earlier investigation and of the availability of metabolite screening and their use in establishing early deficiency.

show abstract

Diagnosis of megaloblastic anaemias

Cited by 140 publications

References 98 publications

Life-threatening megaloblastic pancytopenia with normal mean cell volume: Case series

Life-threatening megaloblastic pancytopenia with normal mean cell volume: Case series

The Syndrome of Food-Cobalamin Malabsorption: A Personal View in a Perspective of Clinical Practice

Are we appropriately testing for vitamin B12 and folate deficiency?

Contact Info

Product

Resources

About