Brigden M L
Island Medical Laboratories, Victoria, BC, Canada.
Postgrad Med. 1995 May;97(5):171-2, 175-7, 181-4 passim.
Because of the widespread use of multiparameter hematology instruments, physicians are often presented with patients who have macrocytosis with no obvious cause. Depending on the demographics of an individual practice, folate and vitamin B12 deficiencies may be relatively rare causes of macrocytosis, compared with alcoholism, liver disease, drugs, or myelodysplasia. Initial evaluation should include a carefully taken history and physical examination along with a complete hematologic profile, reticulocyte count, and peripheral blood smear. This initial evaluation should allow systematic consideration of the possible causes. Serum B12 and red cell folate determinations and other studies may then be undertaken as appropriate.
由于多参数血液学仪器的广泛使用，医生经常会遇到原因不明的大细胞性贫血患者。根据个体医疗实践的人口统计学情况，与酒精中毒、肝脏疾病、药物或骨髓发育异常相比，叶酸和维生素B12缺乏可能是相对少见的大细胞性贫血病因。初始评估应包括详细的病史采集、体格检查以及完整的血液学检查、网织红细胞计数和外周血涂片检查。这一初始评估应能系统地考虑可能的病因。然后可根据情况进行血清维生素B12和红细胞叶酸测定及其他检查。
