Macrocytic anaemia in patients with newly diagnosed anaemia: factors influencing diagnosis and prognosis
Levin, M.D., Stouten, K., Sonneveld, P., Riedl, J.
Voorzitter(s): mw. prof.dr. J. de Graaf, Nijmegen & mw. dr. E.J.M. Mattijssen, Arnhem
Locatie(s): Auditorium 2
Categorie(ën):
Introduction: The frequency of underlying causes of macrocytic anaemia is unclear in medical literature. In addition, the prognosis of underlying causes of macrocytic anemia still have to be established.
Aim of the study: To clarify causes and prognosis of macrocytic anemia in a prospectively studied cohort of patients with newly discovered anemia.
Materials and Methods: Patients with a newly discovered anemia from 63 general practitioners were prospectively studied from the 1st of February 2007 to the 1st of February 2013, with the follow-up period ending on the 1st of July 2013. Patients with macrocytic anemia (i.e. MCV ≥ 100 fl) were included in the study. For each patient a standardised laboratory work-up was performed, which included: haemoglobin, MCV, erythrocytes, erythrocyte sedimentation rate, reticulocytes, thrombocytes, leukocytes, ferritin, transferrin, serum iron, serum vitamin B12, serum folic acid, gamma GT, LDH, creatinin and CRP. Furthermore, a complete hospital chart review (e.g. report on alcohol abuse and medication) was conducted and any additional examinations (e.g. bone marrow examination) were analysed.
Results: A total of 2738 patients with a newly diagnosed anaemia were included. Of these patients 190 (6.9%) displayed macrocytic anaemia (MCV ≥ 100 fl). In 159 of these 190 patients (83.7%) underlying causes could be established. Seven of these 159 patients (4.4%) displayed two causes for their macrocytic anaemia. Classic causes of macrocytic anaemia (haemolysis, possible bone marrow disease, vitamin B12 deficiency, folic acid deficiency and documented alcohol abuse) were found in 85 patients (44.7%). Alternative causes (anaemia of chronic disease, iron deficiency, renal anaemia and other) were found in 77 patients (40.5%). [ML1]
Overall survival of the macrocytic population was 57 months (95% CI 52.6-61.4) after entry into the study. Patients diagnosed with nutrient deficiency displayed a shorter survival (41.8 months, 95% CI 33.2-50.3, P = 0.024) and patients with an unknown cause displayed a longer survival (68.6 months, 95% CI, 60.7-76.5, P = 0.042) than the residual cohort.
Conclusion: The causes of macrocytic anaemia are diverse and include both classic and alternative causes. Therefore we consider a broad diagnostic work-up necessary to elucidate the underlying cause.