Outline
Definisi Pendekatan diagnostik
01 Makrositosis, Anemia Makrositik 06 Laboratory studies
Etiologi
03 Dietary, drug induced
Differential Diagnosis
05
Makrositosis
Mendeskripsikan eritrosit
yang lebih besar dari
normal yaitu MCV (Mean
Corpuscular Volume)
lebih dari 100 fl, jika
proposi MCHC juga
meningkat, makrositosis
tidak selalu dikaitkan
dengan anemia
Anemia Makrosistik
•Pada wanita tidak hamil, Hb < 12 g/dL atau Hct <36%
•Pada wanita hamil, Hb < 11 g/dL
•Pada Laki-laki, Hb < 13 g/dL atau Hct < 41 %
Patofisiologi
Penyebab terseringnya yaitu Anemia Megaloblastik, dimana terjadi impairment pada sintesis
DNA yaitu akumulasi komponen sitoplasma pada sel yang membelah secara lambat. Pada
sel yang membelah cepat, impairment sintesis DNA bisa disebabkan karena terhambatnya
sintesis Thymidylate dan Purin yang disebabkan oleh defisiensi Vitamin B12 dan Asam folat.
Penggunaan obat-obatan seperti Hidroxyurea pada pasien dengan sickle cell disease, serta
pengobatan Zidovudine pada pasien HIV kadang menyebabkan makrositosis.
•Pada Nonmegaloblastik Anemia, tidak ada impairment pada sintesis DNA tetapi lebih
disebabkan oleh peningkatan luas permukaan membran, accelerated eritropoeiesis,
alcoholism dan PPOK.
•Pasien dengan gangguan hepar dan obstructive jaundice sering ada macrostosis, yang terjadi
setelah peningkatan deposisi kolesterol atau fospolipid pada membran sel darah merah yang
beredar bebas, begitu juga pada pasien splenoctomi, membran lipid sel darah merah yang
beredar bebas tidak dilepas selama maturasi di lien, sehingga menghasilkan sel yang normal
atau lebih besar
•Pada pasien PPOK, macrositosis terjadi karena kelebihan air pada sel yang sebelumnya
diawali oleh retensi karbon dioksida
ETIOLOGI
Depresi dan
Simtom yang muncul akibat gangguan
riawayat Headache oksigenasi pada jaringan.
minum
alkohol
Disertai dengan atrofi dan glossitis di lidah
Sore Tongue akibat defisiensi B12 dan asam folat
MYELODYSPLASTIC
SYNDROME
Infographic Style
Splenomegaly dan jaundice
Splenomegaly sangat terlihat jika Takikardi dan Flow Murmur
macrocytosis disebabkan oleh Biasanya pada anemia yg sudah
hemolysis, infiltrative disorders, cukup darah.
atau neoplasms
Jaundice juga bisa karena
hemolysis dan gangguan hati
sehingga meningkatkan MCV
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