Abstract

Background

Anemia can be categorized into micro-, normo- or macrocytic anemia based on the mean corpuscular volume (MCV). This categorization might help to define the etiology of anemia.

Methods

The cohort consisted of patients newly diagnosed with anaemia in primary care. Seven aetiologies of anaemia were defined, based on an extensive laboratory protocol. Two assumptions were tested: (i) MCV <80 fl (microcytic) excludes vitamin B12 deficiency, folic acid deficiency, suspected haemolysis and suspected bone marrow disease as anaemia aetiology. (ii) MCV >100 fl (macrocytic) excludes iron deficiency anaemia, anaemia of chronic disease and renal anaemia as anaemia aetiology.

Results

Data of 4129 patients were analysed. One anaemia aetiology could be assigned to 2422 (59%) patients, more than one anaemia aetiology to 888 (22%) patients and uncertainty regarding the aetiology remained in 819 (20%) patients. MCV values were within the normal range in 3505 patients (85%). In 59 of 365 microcytic patients (16%), the anaemia aetiology was not in accordance with the first assumption. In 233 of 259 macrocytic patients (90%), the anaemia aetiology was not in accordance with the second assumption.

Conclusions

Anaemia aetiologies might be ruled out incorrectly if MCV guided classification is used as a first step in the diagnostic work-up of anaemia. We recommend using a broader set of laboratory tests, independent of MCV.

中文翻译：

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平均红细胞体积引导贫血分类在初级保健中的准确性

摘要

背景

根据平均红细胞体积 (MCV)，贫血可分为微量、正常或大红细胞性贫血。这种分类可能有助于确定贫血的病因。

方法

该队列由在初级保健中新诊断出患有贫血症的患者组成。根据广泛的实验室方案，定义了七种贫血病因。测试了两个假设：(i) MCV <80 fl（小细胞）排除了维生素 B12 缺乏、叶酸缺乏、疑似溶血和疑似骨髓疾病作为贫血病因。(ii) MCV >100 fl（大细胞）排除了缺铁性贫血、慢性病性贫血和肾性贫血作为贫血病因。

结果

分析了 4129 名患者的数据。2422 名 (59%) 患者可分配一种贫血病因，888 名 (22%) 患者可分配一种以上的贫血病因，819 名 (20%) 患者仍存在病因不确定性。3505 名患者 (85%) 的 MCV 值在正常范围内。在 365 名小红细胞患者中，有 59 名（16%）的贫血病因不符合第一个假设。在 259 名大红细胞患者中的 233 名（90%）中，贫血病因不符合第二个假设。

结论

如果将 MCV 指导分类用作贫血诊断工作的第一步，则可能会错误地排除贫血病因。我们建议使用更广泛的实验室测试，独立于 MCV。