Question 25.2

A 62-year-old male has been admitted to your ICU for routine post-operative monitoring after a vascular surgical procedure.

His pre-operative full blood count (FBC) is displayed below:

Parameter	Patient Value	Adult Normal Range
Haemoglobin	125 g/L*	130 – 180
White Cell Count	7.4 x 109/L	4.5 – 11
Platelets	255 x 109/L	150 – 400
Mean Cell Volume	110 fL*	80 – 98
Mean Cell Haemoglobin	30 pg/cell	27 – 33
Mean Cell Haemoglobin Concentration	320 p/L	310 – 360

a) Give six possible causes for the findings on his FBC. (30% marks)

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College answer

Not available.

Discussion

The abnormalities are:

A slightly anaemic haemoglobin, for a dude
A wildly elevated mean cell volume (i.e. macrocytosis)

The cell haemoglobin content is normal, i.e. this is a macrocytic normochromic anaemia.

There are several common causes:

Alcoholism
Vitamin B12 deficiency
Folate deficiency
Myelodysplastic syndromes

There are also a few uncommon causes:

Reticulocytosis
Nonalcoholic and alcoholic liver disease
Hypothyroidism
Multiple myeloma
Aplastic anemia
Acute leukemia
Drugs:
- trimethoprim, triamterine, nitrous oxide, phenytoin, valproate, chemotherapy agents, HIV antiretrovirals and metformin.

References

Aslinia, Florence, Joseph J. Mazza, and Steven H. Yale. "Megaloblastic anemia and other causes of macrocytosis." Clinical medicine & research 4.3 (2006): 236-241.

Walker, H. Kenneth, et al. "Peripheral blood smear." (1990). in Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.

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