From the Guidelines
Non-megaloblastic macrocytic hyperchromic anemia is primarily caused by conditions such as alcoholism, liver disease, hypothyroidism, reticulocytosis, and certain medications, and its management should focus on addressing the underlying condition rather than the anemia itself. The diagnosis of this condition involves a complete blood count showing elevated MCV (>100 fL) and MCHC, peripheral blood smear examination, and specific tests to determine the underlying cause such as liver function tests, thyroid panel, and medication review 1.
Causes and Diagnosis
The causes of non-megaloblastic macrocytic hyperchromic anemia can be identified through a thorough diagnostic approach, including:
- Complete blood count (CBC) to determine MCV and MCHC levels
- Peripheral blood smear examination to rule out other conditions
- Liver function tests to assess for liver disease
- Thyroid panel to evaluate for hypothyroidism
- Medication review to identify potential offending drugs
Treatment and Management
Treatment of non-megaloblastic macrocytic hyperchromic anemia focuses on addressing the underlying condition, which may include:
- Cessation of alcohol consumption for alcoholism
- Hepatology referral for liver disease management
- Levothyroxine replacement for hypothyroidism, typically starting at 25-50 mcg daily, adjusted based on TSH levels
- Discontinuation of the offending drug if medication-induced
- Nutritional support, particularly B-complex vitamins, regardless of the underlying cause
Prognosis
The prognosis for non-megaloblastic macrocytic hyperchromic anemia is generally favorable when the underlying condition is properly managed, with blood parameters typically normalizing within weeks to months of appropriate treatment 1. It is essential to prioritize the management of the underlying condition to improve morbidity, mortality, and quality of life outcomes for patients with this condition.
From the Research
Non Megaloblastic Macrocytic Hyperchromic Anemia
- Non megaloblastic macrocytic anemia is a type of anemia characterized by large red blood cells, but without the presence of megaloblasts, which are large nucleated red blood cell precursors with uncondensed chromatin 2.
- The causes of nonmegaloblastic macrocytic anemia include chronic liver dysfunction, hypothyroidism, alcohol use disorder, and myelodysplastic disorders 2, 3, 4.
- Alcoholism is a common cause of nonmegaloblastic macrocytic anemia, and it can lead to macrocytosis, which is defined as a mean corpuscular volume (MCV) greater than 100 femtoliter (fL) 3, 4, 5.
- Other causes of nonmegaloblastic macrocytic anemia include myelodysplastic syndrome (MDS), liver dysfunction, hypothyroidism, and certain drugs 4.
- The diagnosis of nonmegaloblastic macrocytic anemia involves laboratory tests such as blood smear, vitamin B12 and red blood cell folate levels, reticulocyte count, and thyroid and liver function tests 3.
- The treatment of nonmegaloblastic macrocytic anemia is specific to the underlying cause and may involve addressing the underlying condition, such as treating liver disease or hypothyroidism, or discontinuing certain medications 2, 4.