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Diagnosed with rheumatoid arthritis. Trying for a baby. Have macrocytosis. Will this affect fertility?

DOCTOR OF THE MONTH - Sep 2012
Sep 2012
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General & Family Physician
Practicing since : 2008
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Hello I have been told that I have enlarged blood cells, macrocytosis. I do drink consistently and have done for quite sometime but have given up a month ago as I am trying for a baby. Will it go away? How long will it take? What can I do to help it apart from not drinking and does it effect fertility? And as it could be a B12 or folate defiency will this hurt the baby? I am 30, I also have been diagosed with Rhemutiod Arthritis. Thank you
Posted Thu, 18 Apr 2013 in Getting Pregnant
 
 
Answered by Dr. Das Arindam 35 minutes later
Hello,

Thank you for posting a query.

Look, macrocytosis may be seen in many conditions like megaloblastic anemia (most common), alcohol induced, hypothyroidism, myelodysplastic syndrome and some drugs.

To differentiate these conditions, a complete hemogram containing MCV, MCH, MCHC are required. If hypersegmented neutrophils are found in the peripheral blood smear, then a bone marrow aspiration should be performed to rule out megaloblastic anemia. Only this test can differentiate alcohol induced changes and megaloblastic anemia.

Besides, a vitamin B12 and folic acid estimation should be done to have the levels of these vitamins in blood. In megaloblastic anemia, they are reduced.

Here is a special mention. If you are taking any immunosuppresive agent for rheumatoid arthritis, then you can have this macrocytic changes as a side effects. The most common drug that can lead to this change is methotrexate.

If you are suffering from megaloblastic anemia, you have to take vitamin B12 and folic acid supplements. Within 48 hours, these changes will go away. You will be completely cured within 15 days.

But, in case of alcohol induced changes, you have to wait for months.

Fertility is not affected by this macrocytic change. Basically, drinking affects fertility indirectly.

Apart from not drinking, you have to take vitamin B12 and Folic acid supplements. Because, deficiency in Vitamin B12 and folic acid may lead to congenital abnormality in fetus by reducing the rate of DNA synthesis.

So, consult with your treating doctor about bone marrow examination and vitamin B12 and folic acid estimation to rule out megaloblastic anemia and also for further management accordingly.

Hope this information suffices. Let me know, if you have any more questions.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with rheumatoid arthritis. Trying for a baby. Have macrocytosis. Will this affect fertility? 1 hour later
Hello again, thank you.
I am taking Salazopyrin (Sulfasalazine). So would this be causing it? I am going back to the doctor in a couple of weeks so I will find more about it then but couldn't wait.
So if it is the medication then taking the supplements will fix it? I will be having a blood test before seeing the doctor as well.
So if I were to fall pregnant soon the deficiencies would not effct the baby if I were to start supplements asap? I am already taking a baby multi with 800ug of folate and 4.0mcg of B12. I have been taking these for a long time too.
Thank you
 
 
Answered by Dr. Das Arindam 12 minutes later
Hello,

Thank you for writing back.

Yes, sulfasalazine can cause folate deficiency be inhibiting dihydrofolate reductase. Thus, it can cause megaloblastic changes. Even, it can cause temporary infertility.

Now, in this situation, taking supplements will not be enough. You have to stop the drug first.

In this situation, pregnancy should be avoided. You can try after stopping the drug. You can consult with your treating doctor about it. It will help your doctor to prescribe some safe drugs which does not interfere folate metabolism.

As you are taking the supplements for long time, it is evident that deficiency is not the cause. The drug as well as alcohol are the cause behind this situation.

Hope you have your answers.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with rheumatoid arthritis. Trying for a baby. Have macrocytosis. Will this affect fertility? 2 hours later
Hello,
How long does the drug take to get out of my system and how long would the infertility last?
What are the risks if I became pregnant soon? Providing I could.
I will go back to the specialist, she said the drug would be safe for pregnancy as I went on this one because I was planning to try. None of this was told to me. Would you be able to tell me what it is on a blood test that tells shows I have macrocytosis? I have prints outs of a few as I have them regularly for the Rhemautiod. A different doctor refered me to a fertility doctor so I am taking them there.
Thank you so much for your help
 
 
Answered by Dr. Das Arindam 4 hours later
Hello,

Thank you for writing back.

I am giving your answers one by one.

Look, the infertility is temporary. It means, system gets back to normal immediately after stopping the drug.

I have already told you that the drug can cause congenital malformations by reducing the DNA synthesis.

You should consult with your treating doctor with my reference.

Look, MCV of red blood cell is the parameter which determines the size of blood cells.

Yes. You should consult with infertility specialist also.

Hope you have your answers.

Regards.
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