management in the elderly in general practice

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A macrocytosis will often be an incidental finding. It is worth taking a full history,including:

  • diet
  • alcohol intake
  • mental state
  • medication

This should be followed by a thorough examination.

Routine investigations include:

  • B12 and folate
  • ESR or plasma viscosity
  • gamma GT and liver function tests
  • thyroid function test

If the patient is well and no other abnormality is found, then, in the absence of anaemia, the patient may be left for a time, and the investigations repeated. If investigations are again negative and the repeat full blood count reveals a macrocytosis and no anaemia, then it can be assumed that the patient has a mild marrow dysplasia that can be monitored via regular full blood counts.

Last reviewed 01/2018