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A high MCV is a starting point

An outpatient EDTA CBC has hemoglobin 8.7 g/dL, MCV 114 fL, RDW 19.2%, white blood cells 3.4 × 10^3/microliter, platelets 118 × 10^3/microliter, and reticulocytes 0.6%. Bicytopenia means low values in two cell lines; all three cell lines are low here, so this is pancytopenia: anemia, leukopenia, and thrombocytopenia. The analyzer flags the result for smear review under the local procedure. The question is whether the pattern fits impaired DNA synthesis, reticulocytosis, liver or alcohol effects, medication, or marrow disease.

Mean corpuscular volume is an average of the red-cell volume distribution. It can miss a smaller macrocytic population and can be falsely increased by hyperglycemia, marked leukocytosis, cold agglutinins, delayed room-temperature storage, and aperture problems. Investigate an implausible MCV against specimen condition, analyzer flags, count, hematocrit, and smear before release.

Anemia is not defined by MCV. Use the local CBC reference interval and reportable-range procedures for the result itself.

Guided case CBC collected 09:05 and analyzed 10:00 after acceptable local specimen checks
AnalyteResultIntervalFlag
Hemoglobin8.7 g/dL12.0-16.0 g/dLlow
MCV114 fL80-100 fLhigh
RDW19.2%11.5-14.5%high
WBC3.4 × 10^3/microliter4.0-11.0 × 10^3/microliterlow
Platelets118 × 10^3/microliter150-400 × 10^3/microliterlow
Reticulocytes0.6%0.5-2.0%not increased

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Knowledge check 1

Which findings should prompt a laboratorian to investigate an implausible increased MCV before release?

Choose at least 3 options.

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