Macrocytic Anemia: Causes, Types, Tests, Treatments, and Prevention

Every second you dwell on conditions like Macrocytic Anemia, the more dangerous it will become. So, the early diagnosis would greatly help your recovery.

But here’s more.

So, with this post, we are trying to present you with a helpful piece of information related to Macrocytic Anemia, its types, causes, symptoms, diagnosis, and how you can prevent it from happening.

What is Macrocytic Anemia?

What is Macrocytic Anemia?

Macrocytosis, a condition where the red blood cells become larger in size. In general, the usual size of a red blood cell is 80-100 femtoliters (fL) but when the RBCs cell size surpasses the 100 fL, it is a condition of macrocytosis. 

In addition, when these oversized RBCs are not enough in the count then the whole condition is a case of macrocytic anemia. This would decrease hemoglobin and oxygen-binding which finally generates conditions related to heart and other circulatory disorders.

There are many causes that are responsible for this type of animatic conditions, but the most common cause is the lack of B-12 vitamin and folate.

What are the Causes of Macrocytic Anemia?

In 95% of cases, macrocytic anemia is due to a deficiency of B-12 vitamin and folate. However, there might be other causes that can lead a person to macrocytic anemia, these are: 

  • Liver disease
  • Alcoholism
  • Hypothyroidism
  • Side effects of certain medications such as for cancer, seizures, HIV, etc.
  • Abnormal Autoimmune Responses. 
  • Increased RBC production after blood loss.
  • Myelodysplastic syndrome
  • Metabolic Disorders

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Types of Macrocytosis Anemia

There are two types of Macrocytic Anemia, such as

  1. Megaloblastic Anemias
  2. Non-Megaloblastic Anemias

Megaloblastic Anemia

This type of anemia is due to the inhibition of red cell DNA synthesis. This results in the stoppage (or decrease) of RBCs cell production by the bone marrow. 

And when the body starts repairing these impaired DNA syntheses, you often get Thiamine responsive Megaloblastic Anemia syndrome. 

The main cause of these effects is vitamins deficiency such as Vitamin B12 and folate (vitamin B6). Other causes are hypovitaminosis, and loss of some other micronutrients such as iron, or copper, etc.

Non-Megaloblastic Anemia

Conversely, Nonmegaloblastic anemias are a condition in which there is no DNA synthesis disorder. But they are caused by the condition like 

  • Increased membrane surface area
  • Accelerated erythropoiesis
  • Alcoholism
  • Chronic Obstructive Pulmonary Disease (COPD)

Increased Cell Membrane

Diseases like pathologies of the liver and spleen can trigger the enlargement of cell membranes. 


Chronic alcoholism is responsible for the production of round macrocytes. These macrocytes don’t depend on whether you are deficient in vitamins or not. They only depend on the consumption of liquor. And for the records, this is the most common cause of this macrocytic condition.

Chronic Obstructive Pulmonary Disease (COPD)

In this condition, some physical barriers in the respiratory system can cause the rapid production of red blood cells to carry oxygen.

But here, the default production size is switched to the larger ones. What does that mean? It simply means, those bone marrow cells now start producing larger sized cells than the normal. 

Symptoms of Macrocytosis Anemia

Symptoms of Macrocytosis Anemia

In general, if you’re suffering from anemia, you might develop any symptoms that link your health to macrocytosis anemia condition. This means that you might don’t pose any symptoms but it would be in your system till it gets worse.

Additionally, the symptoms totally depend on your system and its health. And when you get symptoms, it would be like: 

  • Paleness— most common
  • Fatigue and weakness 
  • Confusion
  • Diarrhea
  • Low appetite
  • Depression
  • Infertility
  • Glossitis— swelling or redness of the tongue

The above-listed symptoms are common symptoms for all types of anemia. Therefore, without proper diagnosis, it is nearly impossible to transcribe which type of anemia a patient has.

But here is an exception, if you have macrocytosis anemia due to B12 vitamin deficiency, you would have the following symptoms:

  • Tingling sensation in hands or feet. 
  • Weakness, pain, numbness in limbs
  • Imbalance movement
  • Confusion and sometimes memory loss

Diagnosis For Macrocytic Anemia

Diagnosis For Macrocytic Anemia

To identify the type of anemia, there are generally three types of tests performed; one is Red Blood Count (RBC), second is the Hematocrit Test and the last is, the size determining test.

In general, for these tests, a blood sample is taken from the veins. But if it is a case of macrocytic anemia, sometimes, it would be necessary to take the bone marrow sample.

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Red blood Count (RBC)

As per the name, these are the tests that are used to count the number of RBCs in your blood sample. And for the doctor, the general count number shows the severity of macrocytic anemia.

Hematocrit Test

In this test, an instrument— hematocrit, is used to measure the ratio of the volume of red blood cells to the total volume of blood. Generally, the test is performed from a centrifugation technique. And one common test is the MCH blood test.

And the normal hematocrit values for this test is 

  • 40% and 52% for men
  • 35% and 47% for women

While the normal hemoglobin value is

  • 14 to 18 g/dL
  • 12 to 16 g/dL

Examination for Size and Shape of RBCs

With this test, the doctor can interpret any size and shape abnormalities in the RBCs. However, for macrocytic anemia, the shape is generally considered. And the normal size of RBCs is between 80-100 femtoliters (fL).

Treatment For Macrocytic Anemia

Treatment For Macrocytic Anemia

While treating a macrocytic anemia condition, a doctor prescribes medication on the basis of the causing factor. Once the type of anemia is identified, the doctor usually tries to state a correct nutrient plan to meet with certain vitamin and nutrition deficiencies.

As 95% of people who are suffering from macrocytosis anemia is from the deficiency of B12 and folates. Therefore, the best way to treat this condition is to have B12 and folates in your meals

The doctor might also prescribe some vitamin supplements such as folates and vitamin B12. However, if your body isn’t able to absorb vitamins such as vitamin B12, in that case, you need to need B12 injections.

These are the following some foods that are rich in B12 content:

  • Red meat and chicken
  • Fortified grains and cereals
  • Eggs
  • Fishes and shellfishes

Now, these are the list of some folates rich food:

  • Dark leafy greens vegetables such as kale and spinach
  • Citrus Fruits like oranges
  • Edible legume such as lentils
  • Enriched grains

However, if the condition doesn’t improve with time, these are the following other treatments options:

  • Medication for treating lack of vitamin absorption
  • Changing the medications for certain autoimmune or liver diseases
  • taking medication for thyroid disorders
  • Avoid Alcohol

When the above measures fail to provide any positive results then it means the condition is due to some bone marrow disorder. In those cases, the doctor might suggest blood transfusion or bone marrow transplant.

Prevention From Macrocytic Anemia

As there are no conclusive symptoms, therefore, you can’t control them from happening. But you can do two things; one is to prevent it from damaging your body more and second is to make some lifestyle changes.

So, let’s discuss how practically you can do this.

1. Try to eat more red meat and chicken on at least a weekly basis. This would help you to minimize any threat from the deficiency of B12 vitamin.

Note: If you are a low carb diet for a condition like diabetes then you can also switch to oral vitamin supplements. 

2. In case, you are searching for vegetarian supplements then you can eat dark leafy greens and some beans to compensate for the deficiency of folates and vitamin B12, respectively. 

3. Alcohol should be avoided.

4. Other diseases and conditions such as HIV, antiseizure medication can increase the risk of getting anemic conditions. So, it is better to get vaccinated if possible.

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A condition where the RBCs get scaled up, usually above 100fL, it states a condition of macrocytosis. And when RBCs count is not enough along with macrocytosis, the condition is called macrocytic anemia.

Moreover, 95% of macrocytosis anemia is due to the lack of B12 vitamin and folates. So, if you eat a regular piece of red meat or chicken (if vegetarian beans would be helpful) then the chances of getting this condition are very low.

However, if the macrocytosis anemia is due to some bone marrow disorder, in general, doctors would have to perform surgery for bone marrow transplant.

And at last, if you’re a chronic alcoholic then try to minimize the consumption as it increases the chance of getting macrocytic anemia by 30%.

Now, my friends, these are some frequently asked questions that might help you clear your misconceptions. 

General FAQ

Is Macrocytic anemia serious?

Ans. In general, the condition is mild and can easily be treated with some dietary changes. But if the conditions remain untreated, it might cause major complications. In addition, if you have some other disease, then it could increase the severity.

Who is more likely to get macrocytic anemia?

Ans. Factors such as nutritional factors, alcoholism, elderly, pregnant, vegans, and malabsorptive syndromes are more likely to get this condition.

How a liver disease can cause macrocytic anemia?

Ans. Liver diseases can increase the risk of deposition of cholesterol on the membrane of RBCs. This decreases the oxygen-carrying power and hence it can cause macrocytic anemia.

Is Macrocytic anemia can become a cancerous disease?

Ans. There is a very-very little chance. It only happens due to bone marrow disorder which could trigger other conditions, and cancers would be one of them.

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