A 72-year-old male has presented acutely unwell to the Emergency Department and found to be in acute renal failure. You have been asked to review him.
His Full Blood Count report is as follows:
|
Test |
Value |
Normal Adult Range |
|
White Cell Count |
6.45 x 109/L |
4.0 – 11.0 |
|
Haemoglobin* |
97 g/L |
130 – 180 |
|
Platelets |
181 x 109/L |
150 – 400 |
|
Haematocrit* |
0.282 |
0.40 – 0.54 |
|
Mean Corpuscular Volume* |
101.1 fL |
79 – 99 |
|
Red Cell Count* |
2.79 x 1012/L |
4.5 – 6.5 |
|
Mean Corpuscular Haemoglobin* |
34.8 pg |
27 – 34 |
|
Mean Corpuscular |
344 g/L |
320 – 360 |
|
Red Cell Distribution Width – Standard Deviation |
53.2 fL |
|
|
Red Cell Distribution Width – Coefficient Variation |
14.4% |
10.0 – 17.0 |
|
Neutrophils % |
64.1% |
a)
b)
This is macrocytic hypochromic anaemia.
One can find the many causes of macrocytosis in this article.
Four tests to rule them all?
The college also throws in several other tests, eg. a reticulocyte count and haptoglobin. If one is considering myelodysplasia or B12/folate deficiency, then one might also consider a blood film. Classic morphological features (anisocytosis and poikilocytosis) would be seen in the former. The latter is more characterised by dysplasia of red and white cells with spared platelets. If we are going on this tangent, then one might view a bone marrow biopsy as the ultimate gold standard, but the college did ask for blood tests specifically.
Aslinia, Florence, Joseph J. Mazza, and Steven H. Yale. "Megaloblastic anemia and other causes of macrocytosis." Clinical medicine & research 4.3 (2006): 236-241.