Abstract
Introductionin this study, it is aimed to emphasize the causes and importance of macrocytosis in paediatric practice.Methodsin the paediatric hematology and oncology clinic, 1752 patients evaluated in 2017, patients with macrocytosis were examined retrospectively with clinical and laboratory findings. Patients with macrocytosis were compared with the frequency of severe hematologic diseases such as acute leukemia and bone marrow failure in patients with normocytic and microcytic mean corpusculer volume.Resultsmacrocytosis was detected in 72 out of 1752 patients (4.1%) in the study. Acute lymphoblastic leukemia in 11(15.2%), acute myeloid leukemia in 3(4.1%), Fanconi aplastic anemia in 7(9.7%), Diamond-Blackfan anemia in 2(2.7%), aplastic anemia in 1(1.3%), congenital diseritropoetic anemia in 1(1.3%), deficiency of vitamin B12 in 14(19.4%) were diagnosed. Down syndrome was presented in 33 cases (45.8%). The number of patients with acute leukemia diagnosis was 14(0.8%) in the group in which the mean corpusculer volume was either microcytic or normocytic. The incidence of acute leukemia and bone marrow failure was significantly higher in the group with macrocytosis compared between the two groups.Conclusionalthough vitamin B12 deficiency is considered firstly in patients who have undergone cytopenia and macrocytosis in our country, haematological malignancies, bone marrow failures, myelodysplasia and myeloproliferative diseases should be remembered especially in the individuals with Down syndrome at the same time.
Highlights
Erythrocytes are classified into three morphological groups by their mean cell volume (MCV): microcytic, normocytic, and macrocytic
When 10 patients with bone marrow deficiency were evaluated, the high levels of hemoglobin F (HbF) were detected in all, only mild high levels of AFP was found in only 2 patients with Fanconi aplastic anemia (FAA)
Macrocytosis is rarely observed in children compared to normocytic or microcytic conditions, based on MCV [5]
Summary
Erythrocytes are classified into three morphological groups by their mean cell volume (MCV): microcytic, normocytic, and macrocytic. Macrocytosis is the enlargement of erythrocytes more than 2 standard deviations than the normal value of the age group. The classification by MCV constitutes the foundation of anemia classification used mostly in clinical practice. MCV values vary by age and sex, reticulocyte count and other series are considered important for the examination of patients [1]. Macrocytic anemias are classified into two groups: one is associated with the megaloblastic changes in bone marrow and the other is non-megaloblastic anemia characterized by macrocytosis. Ninety five percent of megaloblastic anemias are caused by deficiency of vitamin B12 and/or folate. Whereas the most frequent causes of non-megaloblastic macrocytosis are neonatal period, reticulocytosis, liver dysfunction, aplastic anemias, and myelodysplastic syndromes [2, 3]. The aim of the present study is to underline the causes and significance of macrocytosis in clinical paediatric practice in Pamukkale University Faculty of Medicine and Diyarbakir Children Hospital Paediatric Hematology-Oncology clinics
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