High MCV, low transferrin, need advice

Hi, last month I had a CBC and metabolic panel done because I started experiencing hair loss during the fall. Anyway, my iron levels are low, and they told me to take iron. When I received my results in the mail, I noticed that my MCV level is 103.4, when normal range is 81-98. I have been a very heavy drinker on and off for 8 years, with this past year being the worst. My b-12 levels are really good, middle of normal range, so that wouldn't cause my high MCV value. It'd either be due to drinking or liver problems... Anyway, I noticed that my transferrin levels are only at 187, when normal range is 250- around 400. The only explanation I can find is liver problems or a chronic disease. However, my liver function test looked great. I was referred to a hematologist who reviewed my lab results and doesn't feel I need to be seen. I'm not sure if he only reviewed my iron levels and overlooked these other abnormal values or what, but I'm really concerned and not sure what to do.

Should high MCV values and low transferrin be a cause of concern? Should I insist on being seen? I can't get an explanation for why those values are out of range.  Does anyone have any experience or knowledge with transferrin or MCV values? How indicative are these values of liver problems?

[Paderla Anitha, DNB]

Hello and hope you are doing well.

For assessing the extent of liver damage due to alcohol, liver function tests are useful. Injury to the liver causes the enzymes to be spilled into the bloodstream. Besides this ultrasonography can help show fatty liver changes due to alcohol. Anemia could most commonly be nutritional and macrocytic anemia is due to vitamin B12 and folic acid deficiency. Discuss these options with your doctor when you happen to meet him next time.

In the meantime you could follow certain precautions. Avoid smoking and alcohol. Avoid
drugs like paracetamol and sedatives. Get vaccinated for hepatitis A and B.
Take a good protein diet.

Hope this helped and do keep us posted.

[krob27]

Thanks! I'm pretty informed on what causes elevated MCV levels. What about transferrin? I can't seem to find anything on that. My b-12 levels are good. I am about to get my folate tested, but I can't imagine that that'd be low. My liver function tests are good so far.. I'm really concerned about the transferrin level being so low. What would cause that other than liver problems?