The macrocytic anemias are a morphological classification of anemias that have an MCV of greater than 100 fL. The MCH is also elevated but the MCHC is within normal range, and these anemias are termed macrocytic/ normochromic. Broadly defined, the macrocytic anemias are divided into two categories: megaloblastic and nonmegaloblastic processes. If the source of the anemia is a vitamin B12 or folic acid deficiency, the anemia is termed megaloblastic. If the source of the anemia is unrelated to a nutritional deficiency, the anemia is macrocytic but not megaloblastic. Vitamin B12 or folic acid deficiency leads to impaired DNA synthesis, a serious condition, and will affect all readily dividing cells, skin cells, hematopoietic cells, and epithelial cells. The effects on the bone marrow, peripheral smear, and the patient's quality of life are dramatic and substantive.
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