Macrocytic Anemias

Author: Margaret Reinhart, MS, MT(ASCP)
Reviewer: Laurie Bjerklie, MA, MLS(ASCP)CM
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Continuing Education Credits

P.A.C.E.® Contact Hours: 1 hour(s)

Florida Board of Clinical Laboratory Science CE Credit Hours

Florida Board of Clinical Laboratory Science CE - General (Hematology): 1 hour(s)

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This course provides an overview of macrocytic anemias. Emphasis is placed on the differential diagnosis of the megaloblastic versus the non-megaloblastic macrocytic anemias. Information is also provided on the pathophysiological processes of each as well as mention of some treatment options. Images and cases are used throughout so as to provide a total picture of these common anemias.

Objectives

  • Differentiate between megaloblastic and non-megaloblastic macrocytic anemias based on the physiological cause of each disease.
  • Differentiate between megaloblastic versus non-megaloblastic macrocytic anemias based on laboratory findings.
  • Associate red blood cell abnormalities seen in blood smears of patients with the different types of macrocytic anemias.
  • Relate each type of macrocytic anemia with symptoms.
  • Identify each of the macrocytic anemias based on case studies.

Course Outline

  • Introduction to the Macrocytic Anemias and Differentiating the Two Major Groups
    • Definition of Macrocytic Anemia
    • How Does an Erythrocyte Become Macrocytic?
    • Megaloblastic and Non-Megaloblastic Macrocytic Anemias
    • Reticulocytosis
    • The major cause of megaloblastic anemias is:
    • Typical red cell indices in most macrocytic anemias are:
  • The Etiology of Megaloblastic Anemia
    • Impairment of Nuclear Development Due to Lack of B12 or Folate
    • Vitamin B12
    • Folate
    • Pernicious Anemia
    • Sources of vitamin B12 in the diet include:
    • The role of intrinsic factor (IF) is:
    • Match the cause with the deficiency.
  • Etiology of Non-Megaloblastic Macrocytic Anemia
    • Causes of Non-Megaloblastic Macrocytic Anemia
    • Alcoholism
    • Drugs
    • Myelodysplastic Syndrome (MDS)
    • A patient has a slightly increased mean cell volume (MCV), along with an elevated red cell distribution width (RDW). Based on this information alone, which of the following statements is true?
    • Which of the following are known to cause non-megaloblastic macrocytic anemia?
  • Laboratory Diagnosis of Megaloblastic Macrocytic Anemia
    • Megaloblastic Anemia: Common Diagnostic Features
    • Megaloblastic Anemia: Blood Smear Analysis
    • Differential Diagnosis of Megaloblastic Anemia: B12 Deficiency and Folate Deficiency
    • Laboratory Diagnosis of Pernicious Anemia
    • Match the test that is specific to the deficiency. If it is found in both B12 and folate deficiencies, indicate "both".
    • Which of the following are common findings in megaloblastic anemias?
  • Clinical Symptoms and Treatments for Macrocytic Anemia
    • Symptoms of Megaloblastic Anemia
    • Symptoms of Non-Megaloblastic Macrocytic Anemia
    • Treatment for Macrocytic Anemia
    • Choose which symptom is not usually seen in megaloblastic anemia due to folate deficiency.
    • The following is the most common treatment for Pernicious Anemia:
    • Neurological symptoms can often be seen in patients with megaloblastic anemia. Match the symptom with its definition.
  • Case Study
    • Case of a 49-Year-Old Patient
    • Based on the CBC results below, how should the anemia be classified?ParameterResultHemoglobin 6.3 g/dLHematocrit 22%WBC 4 x 109/LMCV 128.6 fLMCH 36 pgMCHC 28 g/dL
    • What in the patient's history is suggestive of a B12 deficiency?
    • Which of the following tests would not help differentiate between megaloblastic anemia caused by a B12 deficiency and one caused by folate deficiency?
    • If the patient was diagnosed with a B12 deficiency, which further tests if any, would you do to follow up?
  • References
    • References

Additional Information

Level of Instruction: Intermediate
Intended Audience: Medical laboratory scientists and medical laboratory technicians. This course is also appropriate for medical laboratory science students and pathology residents, as well as other interested healthcare providers. 
Author Information: Margaret Reinhart MS, MT(ASCP), is a senior lecturer at the University of the Sciences where she has taught hematology since 1990. She was also director of the Medical Laboratory Science Program from 1990-2020. In addition, she is an adjunct instructor of Hematology at the Pennsylvania Hospital Medical Laboratory Science program, which is part of the Hospital of the University of Pennsylvania. 
Reviewer Information: Laurie Bjerklie, MA, MLS(ASCP)CM is currently an Education Developer for MediaLab and LabCE. She earned a B.S. in Medical Laboratory Science from the University of North Dakota and an M.A. in Curriculum and Instruction from Saint Xavier University. She has over 15 years of experience in higher education and has held program director and faculty positions in both MLT and MLS programs. She most recently served as the Program Manager of Medical Laboratory Science at Saint Louis University.
Course Description: This course provides an overview of macrocytic anemias. Emphasis is placed on the differential diagnosis of the megaloblastic versus the non-megaloblastic macrocytic anemias. Information is also provided on the pathophysiological processes of each as well as mention of some treatment options.