Causes of Anemia with elevated Mean Corpuscular Volume (MCV) - Differential Diagnosis Algorithm

Normal Blood Smear

 • Drugs

Oval Macrocytes, Hypersegmented Neutrophils

 - Low RBC Folate

     • Dietary Deficiency

     • Malabsorption

     • Increased Requirement (e.g. Pregnancy)

 - Low Serum B12 - Anti-IF Antibodies Present

     • Pernicious Anemia

 - Low Serum B12 - Anti-IF Antibodies Not Present

     • Small Bowel Disorder

     • Pancreatic Disease

     • Parasites

     • Pernicious Anemia

RBCs in Rouleaux Formation

 • Multiple Myeloma

Dysplastic

 • Myelodysplastic Syndromes

Macrocytosis, Target Cells, Normal WBCs

 - Normal Liver Function Tests

     • Rule out B12 and Folate Deficiency

 - Abnormal Liver Function Tests

     • Liver Disease



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