Alcoholic Macrocytic Anemia: Causes, Effects, and Treatment

Anemia is a health disorder that affects the body’s ability to produce and/or maintain healthy red blood cells. ¹ There are multiple types anemia that can be caused by many different underlying triggers including genetics, medications, other medical conditions, and vitamin deficiencies. Chronic alcohol use can result in multiple vitamin B deficiencies and folate deficiency which can result in macrocytic anemia. Alcohol use commonly co-occurs with malnutrition which can also have an effect on red blood cell production, resulting in anemia.^{1, 2,4} Understanding how chronic and heavy alcohol use can result in anemia can hopefully help individuals seek medical care to treat their anemia and underlying alcohol use disorder.

What Is Anemia?

Anemia is a condition that occurs when the body has a lower-than-normal amount of red blood cells or hemoglobin resulting in decreased oxygen carrying capacity to the body’s organs and tissues. This can occur due to many different mechanisms including decreased production of red blood cells, increased destruction of red blood cells and impaired function of red blood cells .¹ Common symptoms of anemia may include:¹

• Fatigue
• Weakness
• Shortness of breath.
• Dizziness
• Headaches
• Abnormal heartbeat
• Decreased mental capacity

There are multiple types of anemia, iron-deficient anemia being the most common, that are classified by their underlying triggers and associated mechanisms. Macrocytic anemia is one type of anemia that is commonly linked to chronic and excessive alcohol misuse as alcohol misuse results in vitamin deficiencies.

What Is Macrocytic Anemia?

Macrocytic anemia is characterized by abnormally enlarged red blood cells that are nutrient-poor and as a result, often break down fast than normal.³

One cause of macrocytic anemia is due to lack of B vitamins and folate which are important vitamins necessary for the healthy production and function of red blood cells. Individuals who have a chronic history of alcohol consumption often have folate deficiency due to malnutrition. Folate deficiency is one of the most common precursors for the development of macrocytic anemia associated with alcohol use disorder.

While studies vary, it is suggested that alcohol use disorder (also known as alcohol addiction) is strongly associated with macrocytosis (macrocytic anemia). ³ Among people who were diagnosed with macrocytosis, 80% of men and 46% of women met the diagnostic criteria for an alcohol use disorder.³

Symptoms of Macrocytic Anemia

Symptoms of macrocytic anemia or alcohol anemia due to folate and B vitamin deficiencies may include:⁴

• Mood disturbances.
• Loss of balance.
• Paresthesia.
• Peripheral neuropathy.
• Constitutional symptoms from primary bone marrow disease.
• Gastrointestinal upset from malabsorption.

Alcohol Addiction Treatment

While not everyone who drinks or who is diagnosed with an alcohol use disorder (AUD) will develop macrocytic anemia, there are still underlying risks. Poor eating habits associated with AUD could potentially lead to vital vitamin deficiencies and malnutrition, leading to macrocytic anemia.⁴ In these cases, taking dietary supplements and fixing nutritional imbalances can be an important part of treatment.⁴

Treating the underlying causes, such as alcohol misuse and addiction, is another effective way of resolving macrocytic anemia.⁴ Evidence-based alcohol addiction treatment methods may yield positive health outcomes.⁵ While experiences in treatment may vary, one may expect alcohol addiction treatment to contain a combination of behavioral therapies and medications for addiction treatment.⁵

Finding Treatment for Alcohol Addiction

If you or a loved one is struggling with alcohol misuse, addiction, or alcoholic macrocytic anemia, it’s important to remember that there is help available. While rehab facilities may not be able to treat anemia, many are able to provide evidence-based addiction treatment. If you’re ready to start searching for addiction treatment, you may consider first approaching your doctor. They may be able to help determine your medical needs or refer you to a suitable treatment program. You may also consider visiting the SAMHSA treatment locator to search for treatment by zip code.

Addiction helplines, like the one owned and operated by American Addiction Centers, can also be a powerful resource. Our compassionate staff stands ready 24/7 to help answer your questions about alcohol addiction treatment, help you find suitable rehab centers, and help you verify your insurance coverage. Don’t delay, contact us today at to get started.