Macrocytic anemias are divided into megaloblastic and non-megaloblastic types. Megaloblastic anemias (due to B12/folate deficiency) show hypersegmented neutrophils and megaloblasts in the marrow. Non-megaloblastic macrocytic anemias have large red cells but normal neutrophil morphology. A very common cause is chronic alcohol abuse. Alcohol has a direct toxic effect on the bone marrow, can cause liver disease (which alters lipid metabolism affecting red cell membranes), and may be associated with nutritional deficiencies, all leading to macrocytosis. Other causes include liver disease, hypothyroidism, certain drugs (like hydroxyurea, azathioprine), myelodysplastic syndromes (MDS), and reticulocytosis (young reticulocytes are larger). In these cases, the MCV is elevated, but the red cells are round, not oval (macro-ovalocytes), and neutrophils are not hypersegmented.

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Zambia

• Naomi Miselo – 31 pts

• Visual Pathway Lesions
• Positive and Negative Symptoms
• Hallucinations and Delusions
• Antipsychotic Medications
• Emergency: Environmental Emergencies