How does one get Macrocytic Anemia without megaloblastic change?

[NeedToStudy]

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I know that it can be caused bed liver disease, alcoholism and 5-flurouracil but what exactly is the mechanism?

 

[syoung]

Alcholism can cause direct negative effects on BM causing macrocytosis w/out megaloblastic change
liver disease can cause codocytes (target cells) which are RBCs with increased surface area, where hemoglobin is in the central portion of the cell, surrounded by a thin pallor, and hemoglobin on the periphery of the cell