Macrocytosis; My Highest MCV Ever!

As far as macrocytosis goes, this is my highest MCV(mean corpuscular volume) ever:  114.  Differential diagnosis anyone? I tell my residents and students I work with that the differential diagnosis is pretty limited. Most commonly
  • alcohol abuse
  • liver disease (usually related to alcohol)
  • hypothyroidism (although I've never seen an MCV that high from thyroid)
  • B12/folate deficiency
  • primary bone marrow failure, usually myelodysplastic syndrome.
  • drug related (certain types of chemo etc...)
I had a patient once who presented with nonspecific complaints and had an MCV of 110 and nothing else. They denied alcohol use or even abuse. I confronted them with my suspicions about alcohol abuse based on this abnormal lab and they broke down in tears about their long standing closet drinking.

see my other record clinical findings.

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6 Outbursts:

  1. MCV 114??
    Sounds like a friggin license plate..

    Is that something I'm supposed to know as a doc?? Must have missed that day.


  2. "THEY" denied alcohol use?
    you confronted "THEM"?
    "THEY" broke down in tears..about "THEIR" drinking??
    Who was your friggin patient, Sybil??
    Siamese Twins??


  3. Ohio OncologistMay 3, 2009 at 6:30 PM

    You forgot one Happy. Autoimmune hemolytic anemia. Typically a slightly lower MCV. The high MCV is caused by a high retic count. The most common chemo causing this is Hydrea.

  4. Gamma glutaryl transaminase (GGT) or Ethyl glucuronide testing (EtG) are easily obtained and diagnostic. Elevation of the GGT can occur with liver disease other than alcoholic.

    Nothing gives a positive EtG except ingestion of ethanol, and it's detectable up to 80 hours after ingestion, long after the blood and breath tests are negative.

  5. i thought MCV was a Medical Skool. In Virginia.

  6. What happened, Frank? You bought Happy a drink and the third base coach gave you the hold-up sign?


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