▁ret icul ocy te ▁count ▁may ▁be ▁helpful . ▁Non - m eg al ob last ic ▁macro cy t ic ▁an em ias ▁with ▁a ▁low ▁ret icul ocy te ▁count ▁( ind ic ating ▁a ▁poor ▁b one ▁mar row ▁response ▁to ▁the ▁an emia ) ▁suggest ▁li ver ▁disease ▁( e . g ., ▁cir r hos is ), ▁hypoth y roid ism , ▁to xic ▁effects ▁of ▁alco hol ▁on ▁the ▁b one ▁mar row , ▁or ▁my el od ys pl asia . ▁In ▁contrast , ▁non - m eg al ob last ic ▁macro cy t ic ▁an em ias ▁associated ▁with ▁a ▁high ▁ret icul ocy te ▁count ▁( ret icul oc yt osis ) ▁may ▁be ▁caused ▁by ▁hem ol ysis ▁or ▁ble eding . ▁ ▁For ▁meg al ob last ic ▁macro cy t ic ▁an em ias , ▁useful ▁tests ▁may ▁include ▁ser um ▁levels ▁of ▁Vit amin ▁B 1 2 , ▁m eth yl mal onic ▁acid , ▁and ▁hom oc yst e ine . ▁If ▁there ▁is ▁no ▁clear ▁evidence ▁of ▁Vit amin ▁B 1 2 ▁or ▁fol ic ▁acid ▁def ic iency , ▁additional ▁causes ▁of ▁meg al ob last ic ▁an emia ▁include ▁co pper ▁def ic iency , ▁medic ations , ▁and ▁certain ▁in born ▁errors ▁of ▁met abol ism . ▁ ▁Ep ide mi ology ▁Mac ro cy t ic ▁an em ias ▁have ▁several ▁causes ▁but ▁with ▁the ▁implementation ▁of ▁fol ic ▁acid ▁fort ification ▁in