The Macrocytosis in Cirrhosis of the Liver

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Abstract
A clinical and experimental study was made of macrocytosis in histologically proven cirrhosis of the liver. Its incidence was found to be 55.5% in human subjects and 36.0% in animals. In both, the increase in red cell diameter paralleled liver damage and the frequency of macrocytic anemia was highest in severe cirrhosis. The macrocytosis did not bear any relation either to the severity of anemia, or the reticulocyte response, or the level of billirubin in blood. Blood smears showed minimal anisocytosis but there was considerable variation in the thickness of macrocytes. The red cells were thicker than normal in 8 and thinner in 10 of the 25 patients who suffered from macrocytic anemia. In the rest the MCT [mean red cell thickness] was within normal limits. Bone marrow changes in patients with cirrhosis indicate that the macrocytes are due to abnormal maturation of their precursors. Neither splenectomy nor the administration of vitamin B12 prevented the development of macrocytosis following experimental cirrhosis.