Required section · Section 2 of 6
Sort the pattern before naming a cause
Macro-ovalocytes are enlarged oval red cells; hypersegmentation means a neutrophil with more nuclear lobes than expected. Together they support a megaloblastic pattern of impaired DNA synthesis. Dysplasia means abnormal cellular maturation and requires qualified morphology review; it is not established by one automated result. Round macrocytes fit nonmegaloblastic patterns and redirect the differential.
Reticulocytes are larger than mature red cells, so a regenerative response can increase MCV. Increased reticulocytes prompt correlation for hemolysis, blood loss, or recovery after treatment. Low reticulocytes in the guided case argue against a regenerative explanation.
Illustrative drawing — this picture was drawn rather than captured.
Review sequence for an increased MCV
Confirm the result
Review specimen condition, analyzer flags, count, hematocrit, and local smear-review criteria.
Classify morphology
Distinguish macro-ovalocytic findings with hypersegmented neutrophils from round macrocytosis or concerning dysplasia.
Assess reticulocytes
Determine whether an increased reticulocyte response can account for the MCV.
Target correlation
Use nutrient markers, renal context, chemistry, thyroid testing, medication context, and qualified review as appropriate.
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The module finishes after every required section is marked done and every check in those sections is correct.