Diagnostic clues to megaloblastic anaemia without macrocytosis

• Published in: International journal of laboratory hematology 2007-06, Vol.29 (3), p.163-171
• Main Authors: CHAN, C. W. J., LIU, S. Y. H., KHO, C. S. B., LAU, K. H. T., LIANG, Y. S., CHU, W. R., MA, S. K. E.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anemia, Iron-Deficiency - diagnosis; Anemia, Macrocytic - diagnosis; Anemia, Megaloblastic - diagnosis; Anemia, Pernicious - complications; Autoanalysis; Blood Cell Count; Chronic Disease; Diagnosis, Differential; Erythrocyte Indices; Female; Humans; Male; Megaloblastic anaemia; Middle Aged; Postgastrectomy Syndromes - complications; Thalassemia - diagnosis; Vitamin B 12 Deficiency - complications; without macrocytosis
• ISSN: 1751-5521; 1751-553X
• DOI: 10.1111/j.1751-553X.2007.00911.x

Summary Masking of the macrocytic expression of megaloblastic anaemia (MA) by coexisting thalassaemia, iron deficiency and chronic illness has been widely reported. We described the haematological and clinical features of 20 Chinese patients with MA presenting with mean corpuscular volume (MCV) ≦99 fl, and analysed the steps leading to the final diagnosis of MA with concomitant thalassaemia trait (n = 11), thalassaemia trait and iron deficiency (n = 3), iron deficiency (n = 4) and chronic illness (n = 2). We also compared the haematological characteristics of this group of patients with a group of normocytic anaemic patients without vitamin B12/folate deficiency, and identified certain laboratory information useful for differentiating the two groups. Statistically significant parameters included the mean values of haemoglobin, MCV, red cell distribution width (RDW), reticulocyte index, platelet count and serum bilirubin. All provided clues to maturation disorders within the marrow. A decision flowchart for the diagnosis of MA without macrocytosis was proposed. In the studied population, by using the parameters of haemoglobin