Macrocytosis

Emmanuel C. Besa, MD

Thomas Jefferson University, Jefferson Medical College, Philadelphia, PA

This case was reviewed and updated in 2009 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.

Bone Marrow Examination
BUN Creatinine
Ferritin
Liver Panel with LDH
Methyl Malonic Acid (MMA) and Serum Homocysteine
Peripheral Blood Smear
Reticulocyte Count
Serum folate/Red Blood Cell (RBC) folate
Serum Vitamin B12

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