Evaluation of macrocytosis by general practitioners.

OBJECTIVE: Macrocytosis is considered to be an important sign of disease, although it often seems to be ignored. The aim of the present study was to assess the quality of the work done by general practitioners using macrocytosis as an indicator. METHODS: All consecutive outpatients at Tampere City Health Center who had blood counts taken during 8 months in 1990 and were found to have macrocytosis (MCV > or = 100 femtoliters) that had not earlier been examined, were included in this study. The further examinations undertaken were analyzed. RESULTS: Of the 9,527 blood counts, previously unexamined macrocytosis was found in 3% (n = 287, 154 men and 133 women). Further examination because of macrocytosis was undertaken in 65 (42%) men and in 48 (36%) women. Alcohol abuse was the most common disease present in 52 (80%) men and in 22 (46%) women. No cause for macrocytosis was found in seven men and in 17 women. No difference between the examined and unexamined groups was found concerning medical history, medications, symptoms, or blood count values, including hemoglobin and MCV. CONCLUSIONS: Evaluation of macrocytosis, when undertaken, was well done by general practitioners. However, it was performed too seldom and, thus, several diseases, especially alcohol abuse, may have been overlooked.

Blood count and hematologic morphology in nonanemic macrocytosis: differences between alcohol abuse and pernicious anemia.

In order to find out if blood count parameters could help to differentiate between the two most common causes for nonanemic macrocytosis, alcohol abuse and vitamin B12 deficiency, we studied 18 nonanemic pernicious anemia patients and 136 alcohol abusers without deficiency of folate and with an erythrocyte mean cell volume (MCV) value > or = 100 femtoliters. In addition to blood count reticulocytes, peripheral blood smear and marrow aspirates were examined. The combination of a low red cell count (< 4.0 x 10(12)/l) or a high red cell distribution width (E-CDW) value (> 15.0%) with a normal thrombocyte count and a normal thrombocyte mean cell volume (T-MCV) was found in 94.4% of the vitamin deficient patients but in only 14.6% of the abusers, in 25.0% of the folate deficient patients (n = 8), and in 26.9% of the patients without any cause for macrocytosis (n = 52). None of the peripheral blood smear or marrow findings exceeded this sensitivity, and the few highly specific findings had low sensitivities. Thus, the combination of the four blood count parameters proved to be, as compared to hematologic morphology, a good diagnostic tool in selecting patients for appropriate further diagnostic tests. All patients with macrocytosis should be asked about their alcohol consumption. Additionally, serum B12 vitamin should be measured at least when nonanemic macrocytosis is combined to a low red cell count or a high E-CDW and the thrombocyte count and T-MCV are normal.

Incidence and survival rate in cases of biopsy-proven temporal arteritis.

In the population of the city of Tampere, Finland, 66 patients with histologically verified temporal arteritis were identified during the 20-year period from 1969 to 89. The cases were followed up to March 31st in 1991. The annual age- and sex-adjusted incidence of temporal arteritis per 100,000 population aged 50 or older was 4.5 in 1970-79 and 9.2 in 1980-89. The patients showed excess mortality although this was not statistically significant. After excluding hypertensive disease, angina pectoris and congestive heart disease the survival of the remaining subgroup did not differ from the control population.

Alcohol-induced macrocytosis and blood pressure.

The effect of alcohol on blood pressure was studied prospectively in consecutive general practice patients with macrocytosis (MCV greater than or equal to 100 fl). The patients were separated into misuser and non-misuser groups on the basis of the Malmö modified Michigan Alcoholism Screening Test. There was no significant difference in the prevalence of antihypertensive medication between the misuser and non-misuser groups. When patients using antihypertensive medication were excluded and the groups were age-adjusted, male misusers (n = 95) compared to control patients (n = 22) had significantly higher diastolic (88 mmHg and 81 mmHg, respectively, P = 0.001) and systolic (146 mmHg and 137 mmHg, respectively, P less than 0.001) blood pressure values. Female misusers (n = 24), as compared to female non-misusers (n = 59) had significantly higher diastolic (83 mmHg and 82 mmHg, respectively, P = 0.04) but not systolic blood pressure values. Thus, alcohol seems to have a pressor effect predominantly among men. As 72% of men with macrocytosis were alcohol misusers and 41% of them either had elevated systolic or diastolic blood pressure, all patients with macrocytosis should be asked about their alcohol consumption and at least the males should have blood pressure measured.

Macrocytosis as a consequence of alcohol abuse among patients in general practice.

Macrocytosis, a common finding in patients without anemia or other hematologic abnormalities, is often ignored. The purpose of this prospective study was to investigate 300 consecutive, adult health-center patients with a mean cell volume (MCV) value greater than or equal to 100 fl. The incidence of macrocytosis was 2.4%. Of the 177 male and 123 female patients, only 14 (4.7%) were anemic; 80.2% of the men (89.3% of those under 60 years) and 34.1% of the women were alcohol abusers, representing the largest diagnostic group. The highest MCV value found in alcoholics without folate or vitamin B12 deficiency was 120 fl. The most useful laboratory test for identifying alcohol abuse among macrocytic patients was the measurement of serum gamma-glutamyltransferase. Of the several morphologic abnormalities in the marrow the only specific finding were vacuoles in the granulocyte or erythrocyte precursors. No underlying cause was found for macrocytosis in 6.8% of the men and 35.8% of the women. Even when it is not associated with anemia, macrocytosis should not be ignored. It may be the only indicator of a disease which often, particularly in young and middle-aged men, is alcohol abuse.