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Curr Opin Nephrol Hypertens 25:363371

Common clinical drivers include: Vitamin B12 deficiency Folate deficiency Chronic liver disease Alcohol use disorder Medications (e.g., methotrexate) Bone marrow disorders Chronic inflammatory disease Hypothyroidism Key ICD-10 principle: Cell size is a laboratory observation

However, Inoue et al

The mechanism of toxicity of copper at the cellular level may be a combination of several different copper-sensitive processes that include inhibition of cytosolic enzymes and pro-oxidant effects that damage plasma membrane function and alter oxidative phosphorylation in mitochondria

For others, its a bit more gradual