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.

VI. PROGNOSIS/CLINICAL COURSE

Over the next few years, the patient develops progressive anemia. Considering the patient’s history of gastric surgery, her primary care physician decides to maintain the patient on vitamin B12 (cyanocobalamin) shots. These do nothing to reverse the worsening anemia and mild neutropenia. Four years later, she is sent back to you for evaluation.

Present Lab Values
Test Patient Results Normal
CBC Hb
Hct
MCV
MCH
RDW
WBC
8.8 g/dL
26.5%
119 fL
39.7 pg
17.5 SD
5,200/μL
(12-15.6)
(35-46)
(80-100)
(27-33)
(9-15)
(4,800-10,800)
Differential Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
67%
30%
8%
3%
2%
(42-75)
(20-51)
(5-10)
(0-7)
(0-7)
Platelet 338,000/μL (150,000-400,000)
Folic Acid
B12
6.4 µg/dL
1579 pg/mL
(>1.9) (deficient <1.7)
(232-1139) (deficient <160)

What is your interpretation of these findings? Consider each of the following and click on the most likely cause(s).

Macrocytic Anemia
Pancytopenia
Neutropenia
Thrombocytopenia

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