Macrocytosis

Emmanuel C. Besa, MD

Thomas Jefferson University, Jefferson Medical College, Philadelphia, PA

This case was reviewed and updated in March 2013 by Dr. Howard A. Liebman and members of the Teaching Cases Subcommittee.

Copyright of the American Society of Hematology, 2006. ISSN: 1931-6860.

III. LABORATORY DATA

The patient gives you the results of her most recent CBC, shown below.

CBC:
  Patient Results Normal Values (range)
  Hb
Hct
MCV
MCH
RDW
WBC
11.2 g/dL
34%
105 fL
35.8 pg
14.9 SD
6,200/μL
(12-15.6)
(35-46)
(80-100)
(27-33)
(9-15)
(4,800-10,800)
Differential:
  Patient Results Normal Values (range)
  Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
59%
30%
8%
3%
1%
(42-75)
(20-51)
(5-10)
(0-7)
(0-7)
Platelets 312,000/μL (150,000-400,000)


Which laboratory tests should be ordered? Consider each of the following and click on the laboratory studies you believe will most help you make a diagnosis.

Peripheral blood smear
Bone marrow examination
BUN creatinine
Ferritin
Liver panel with LDH
Reticulocyte count
Serum folate / Red blood cell (RBC) folate
Serum vitamin B12
Methyl malonic acid (MMA) and serum homocysteine

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