Causes of Anemia with elevated Mean Corpuscular Volume (MCV) - Differential Diagnosis Algorithm
Normal Blood Smear
• Drugs
Oval Macrocytes, Hypersegmented Neutrophils
- Low RBC Folate
• Dietary Deficiency
• Malabsorption
• Increased Requirement (e.g. Pregnancy)
- Low Serum B12 - Anti-IF Antibodies Present
• Pernicious Anemia
- Low Serum B12 - Anti-IF Antibodies Not Present
• Small Bowel Disorder
• Pancreatic Disease
• Parasites
• Pernicious Anemia
RBCs in Rouleaux Formation
• Multiple Myeloma
Dysplastic
• Myelodysplastic Syndromes
Macrocytosis, Target Cells, Normal WBCs
- Normal Liver Function Tests
• Rule out B12 and Folate Deficiency
- Abnormal Liver Function Tests
• Liver Disease
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