RBC Panel

My wife's recent RBC Panel
RBC   4.6
Hg   13.7
HCT  44.7
MCV  98
MCH  30.0
MCHC 30.6
RDW  14
Paltelets 353
WBC  11.2
Folic acid >20
B-12   329

While these are all in the norm range, there are some things that are unusual for her.  This is her highest ever HCT - 44.7 and MCV - 98; and the lowest ever MCHC - 30.6.  She has had 6 prior labs over the last 8 yrs.  Here HCT has ranged from 36 to 40.9; MCV from 86 to 88; and MCHC from 33.5 to 35.  It is also the highest ever RDW - 14.  In the past she has been from 12.2 to 13.3.  Here are the results of an lab from 18 mos ago:

RBC   4.5
Hg   13.3
HCT  39.1
MCV  87
MCH  29.6
MCHC 34
RDW  13.3
Paltelets 346
WBC   8.8

I have played with the numbers, it seems that if all things are held constant and you increase MCV, then HCT goes up and MCHC goes down.  Her folic acid is above normal and b12 (329) in range (243 - 894).

My wife is 36 and feels normal.  

Is there anything here to been concerned about?

As a side note she was treated for infertility.  We attempted IVF and failed twice - 12 mos ago and 24 mos ago.  Cause of infertility is unkown - we have been for all the tests.  Could the MCV increase be from the treatment?

[Kevin Pho, MD]

If the values are within the normal limit, the chance of a blood disease is less likely.  There will be variation from test to test simply based on the lab assay.  No two numbers will be exactly alike.  

An MCV above 100 would be abnormal.  The following diseases can lead to this:

* The presence of an increased number of reticulocytes
* Macrocytosis associated with alcoholism
* Deficiency of folic acid or vitamin B12
* Antiviral treatment of HIV infection
* Use of chemotherapeutic agents, especially hydroxyurea
* Presence of the myelodysplastic syndrome.

If there are no symptoms and the CBC remains within normal limits, it is unlikely that further testing is needed.

If there continues to be concern, you can consider serial testing of the CBC to ensure the values do not worsen.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[White_Lotus]

A related discussion, Difference between increased reticulocytes and myelodysplastic syndrome was started.