Dante Carrillo
Macrocytic anemia is a condition where your red blood cells are too large. It is most often caused by a lack of vitamin B-12 and folate in the diet, but can also be caused by other underlying conditions. A doctor will ask about your medical history, lifestyle, and eating habits to determine whether your diet is deficient in iron, folate, or any of the other B vitamins. While it is difficult to get enough iron from diet alone, eating a healthy diet rich in dark, leafy greens, nuts and seeds, seafood, meat, beans, and vitamin C-rich fruits and vegetables can help manage anemia.
| Characteristics | Values |
|---|---|
| Cause | Lack of vitamin B-12 and folate |
| Dietary sources of vitamin B-12 | Liver/liver pâté, meat (beef, lamb, pork), fortified breakfast cereals, fortified oat/rice/soya milk, fortified soya yogurts, fortified spreads, fortified yeast extract |
| Dietary sources of folate | Leafy greens (Swiss chard, collard greens), citrus fruits, beans, whole grains |
| Other causes | Underlying conditions, medications (e.g. chemotherapy drugs, antiseizure medications, antiretroviral drugs), alcohol consumption |
| Treatment | Dietary changes, supplements, vitamin B-12 injections |
| Prevention | Eating a healthy diet rich in iron, B vitamins, vitamin C, and folate |
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What You'll Learn
Vitamin B-12 deficiency
Macrocytic anemia is a condition where your red blood cells are too large. Most cases of macrocytic anemia are caused by a vitamin B-12 deficiency. This is usually treated and cured with supplements and dietary changes.
Vitamin B-12 is an essential nutrient that plays a critical role in the body. It is mainly found in animal products, especially meat and dairy products, as well as fortified foods and dietary supplements. Organ meats, such as liver and kidneys, are very high in vitamin B-12. Other good sources include beef, sardines, clams, dairy, and rainbow trout. For vegans, nutritional yeast and fortified foods can be good sources of vitamin B-12.
If you think you may have a vitamin B-12 deficiency, it is important to speak to your doctor. They may ask about your medical history, lifestyle, and eating habits to determine if your diet is deficient in vitamin B-12 or other nutrients. Blood tests can then be carried out to check for anemia and enlarged red blood cells.
It is important to treat vitamin B-12 deficiency as it can cause long-term complications if left untreated, including permanent damage to your nervous system.
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Folate deficiency
Folate, also known as folic acid, is a type of B vitamin that helps the body make red blood cells. A folate-deficient diet can lead to macrocytic anaemia, a condition characterised by red blood cells that are larger than normal. This is because folate deficiency impairs DNA synthesis, causing the body to produce red blood cells incorrectly.
Folate-deficiency anaemia is typically treated with a well-balanced diet of folic-acid-rich foods, folic acid supplements, and medicines. Folic acid is found naturally in leafy vegetables, citrus fruits, beans, whole grains, and fortified cereals. Pregnant women are advised to consume 400 to 800 micrograms of folic acid daily before and during pregnancy to prevent neural tube defects in infants.
Folate-deficiency anaemia can be diagnosed through blood tests and a barium study if a digestive problem is suspected. Treatment for folate-deficiency anaemia usually lasts for at least 2 to 3 months, and may include pills or injections of folic acid. Addressing underlying digestive tract problems may also be necessary.
While most cases of folate-deficiency anaemia can be resolved through dietary and supplementary interventions, complications may arise if left untreated. In rare cases, severe or prolonged folate deficiency may contribute to permanent damage to the nervous system.
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Iron deficiency
Macrocytic anemia is a condition characterised by abnormally large red blood cells that cannot carry enough oxygen throughout the body. It is caused by a vitamin B12 or folate deficiency, which results in impaired DNA synthesis. The condition can also be caused by alcohol use, hereditary spherocytosis, hypothyroidism, liver disease, or conditions causing increased reticulocyte production.
Vitamin B12 and folate are required for Thymidylate and purine biosynthesis. A B12-deficient diet without supplementation or a history of gastric surgery can cause vitamin B12 deficiency. Alcohol use can also lead to B12 and folate deficiency and has a direct toxic effect on erythroid precursors.
Folate deficiency is prevalent in 40% of patients with cirrhosis, while B12 deficiency is prevalent in 30% to 40%. Megaloblastic anemia, the most common form of macrocytic anemia, occurs when a person cannot produce DNA due to a B12 or folate deficiency. It is marked by hypersegmented neutrophils and large oval red blood cells. Nonmegaloblastic anemia, on the other hand, lacks hypersegmented neutrophils and can be caused by a liver, spleen, or bone marrow problem.
Treatment for macrocytic anemia depends on the underlying cause. Most cases can be treated and cured with dietary changes and supplements.
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Vegetarian/vegan diets
Vegetarian and vegan diets can cause macrocytic anaemia due to a vitamin B12 deficiency. This is because vitamin B12 is mainly found in animal products, so those following a vegetarian or vegan diet may not be consuming enough.
Vitamin B12 is essential to red blood cell formation. When the body lacks vitamin B12, it produces red blood cells that are larger than normal, resulting in megaloblastic anaemia, a type of macrocytic anaemia.
Megaloblastic anaemia can also be caused by a folate deficiency, which is common in those following a vegetarian or vegan diet. Folate is found in beans and dark, leafy greens, so those on a vegetarian or vegan diet can ensure they are consuming enough folate by including these foods in their meals.
In addition to vitamin B12 and folate, iron is another molecule essential to red blood cell formation. A lack of iron can cause anaemia, so it is important for those on a vegetarian or vegan diet to ensure they are getting enough iron.
If you are following a vegetarian or vegan diet and are concerned about anaemia, it is important to keep in touch with your healthcare provider and ensure you are getting the necessary supplements.
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Alcohol consumption
Chronic and heavy alcohol use can result in multiple vitamin B deficiencies, including vitamin B-12 and folate deficiencies, which are the most common causes of macrocytic anaemia. Alcohol use is also commonly associated with malnutrition, which can further impact red blood cell production and lead to anaemia. Poor eating habits and malnutrition related to alcohol use disorder can result in vital vitamin deficiencies, increasing the risk of developing macrocytic anaemia.
The risk of developing macrocytic anaemia due to alcohol consumption is not limited to those with an alcohol use disorder (AUD). However, those with AUD are at a higher risk due to the potential for poor eating habits and malnutrition, which can lead to vitamin deficiencies.
To diagnose macrocytic anaemia, a doctor will typically ask about a patient's lifestyle, eating habits, and medical history. Blood tests, such as a complete blood count and a peripheral blood smear, can then be used to confirm the diagnosis and identify any nutrient deficiencies that may be contributing to the condition.
Treating the underlying cause of macrocytic anaemia is essential for resolving the condition. In the case of alcohol-induced macrocytic anaemia, this involves addressing the patient's alcohol misuse or addiction through evidence-based addiction treatment methods, such as behavioural therapies and medications. It is important to seek professional help and support when dealing with alcohol addiction and its associated health complications.
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Frequently asked questions
A diet lacking in vitamin B-12 and folate can cause macrocytic anemia. This is because your body needs these vitamins to make red blood cells.
Meat, such as beef, lamb, pork, chicken, and liver, is rich in vitamin B-12. Other sources include fortified foods, such as breakfast cereals, milk, and yoghurt.
Leafy greens, citrus fruits, beans, and whole grains are good sources of folate.
Yes, macrocytic anemia can also be caused by underlying conditions, such as pernicious anemia, gut conditions, or hypothyroidism. It can also be caused by certain medications or by heavy alcohol consumption.
