Imuran-induced macrocytosis and splenectomy following renal transplantation
Proctor, S.J.; Walker, W.; Rai, C.
Transplantation 22(4): 404-406
1976
ISSN/ISBN: 0041-1337 PMID: 790697 Document Number: 103713
The MCV . Before transplant, there was a difference in the values of MCV between the normocytic and macrocytic groups, significant at the 0.025 level. Both groups showed a rise of MCV in the year post-transplant when they were receiving azathioprine treatment, 17 fl for the macrocytic group compared to 9.5 fl for the normocytic group. However, the difference in rise between the 2 groups was not significant (P = 0.2). Megaloblastic erythropoiesis is common in patients receiving azathioprine and is due to a direct effect of the drug on purine metabolism. This is probably the main factor causing macrocytosis following renal transplant but the degree of macrocytosis varies and additional factors also operate. Two such factors are the pretransplant MCV and the presence or absence of a functioning spleen. In this series, the normocytic group had a significantly lower pretransplant MCV level than the macroyctic group so that the increase in MCV caused by azathioprine therapy in the former group was not expressed as marked macrocytosis (MCV greater than 105 fl). More than 1 factor governs the degree of macrocytosis in transplant patients on azathioprine treatment and gross macrocytosis itself cannot be used as an indicator of marrow toxicity or degree of immunosuppression.