management in the elderly in general practice
A macrocytosis will often be an incidental finding. It is worth taking a full history,including:
- alcohol intake
- mental state
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