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Megaloblastic Macrocytic Anemia: Likelihood Ratios

Introduction: This is one of the principal mainfestations of Vitamin B12 (cobalamin) deficiency. It is the sole manifestation of Folate Deficiency in the adult. The other major manifestation of B12 deficiency is neurological: subacute combined degeneration of the spinal column and/or dementia. One common cause of B12 deficiency is Pernicious Anemia.

Other causes of macrocytic anemia include Alcoholism, reticulocytosis, and MDS.

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Tags: Hematologic Metabolic Tag this Diagnosis.

The likelihood ratios of findings for Megaloblastic Macrocytic Anemia are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding +LR-LR Comments, Study
Serum B12 Edit 200

< 200pg/ml. In patients with MCV > 100. For a diagnosis of B12 deficiency specifically.

In other series, sensitivity is not 100% - per PMID 2339684, a series of pernicious anemia patients who were receiving less than the proper maintenance dose had elevated MMA levels in 95% of the case while decreased cobalamin was only present in 69%. In the same study, a series of 400 patients with "clinically significant" B12 deficiency had a 97% sensitivity for low B12 levels.

Study: Am J Med Sci. 2000 Jun;319(6):343-52. PMID: 10875288

Macroovalocytes Edit 5.60

In patients with MCV > 100.

Study: Am J Med Sci. 2000 Jun;319(6):343-52. PMID: 10875288

Neutrophil Hypersegmentation Edit 300.1

in patients with MCV > 100

Study: Am J Med Sci. 2000 Jun;319(6):343-52. PMID: 10875288

Either Low Serum B12 or Low Serum Folate Edit 10.50.2

In patients with MCV > 100. (B12 < 200pg/ml, Folate < 2.1ng/ml)

Study: Am J Med Sci. 2000 Jun;319(6):343-52. PMID: 10875288

Elevated Serum Methylmalonic Acid or Homocysteine Edit 3.30.2

either elevated: MMA > 376 nM, HCys > 21.3 uM. In patients with MCV > 100.

Extreme elevations found solely in B12 deficiency. False positives occur often from renal failure or hypovolemia.

Study: Am J Med Sci. 2000 Jun;319(6):343-52. PMID: 10875288

Anisocytosis Edit 2.20.2

>2+ by scoring system. In patients with MCV > 100.

Study: Am J Med Sci. 2000 Jun;319(6):343-52. PMID: 10875288

Increased MCV
Duplicate Edit
30.3

>110 fL. In patients with MCV > 100 fL.

Study: Am J Med Sci. 2000 Jun;319(6):343-52. PMID: 10875288

Good Positive Likelihood Ratio

Finding +LR-LR Comments, Study
Increased MCV
Duplicate Edit
160.8

>120 fL. In patients with MCV > 100.

Study: Am J Med Sci. 2000 Jun;319(6):343-52. PMID: 10875288

High LDH Edit 110.8

>1000 U/L. In patients with MCV > 100.

Study: Am J Med Sci. 2000 Jun;319(6):343-52. PMID: 10875288

Poorly Diagnostic Findings

Finding +LR-LR Comments, Study
RDW, increased Edit 1.10.8

>14.5%. In patients with MCV > 100.

Study: Am J Med Sci. 2000 Jun;319(6):343-52. PMID: 10875288