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Anemia causes

1. Anemia without increased reticulocytes

Decreased MCV

  • Iron deficiency anemia
    Clinical suspicion: Microcytic hypochromic anemia.

  • Thalasthemia
    Clinical suspicion: microcytic hypochromic anemia without increase in reticulocyte count not caused by iron deficiency with morphological abnormalities in peripheral blood smear. In severe cases bone abnormalities & splenomegaly.

Normal MCV

  • Myelodysplastic syndrome
    Clinical suspicion: Normocytic anemia & reticulocytopenia not diagnosed conventionally will require a bone marrow aspirate and subsequently a bone marrow biopsy OR macrocytic anemia not found to be due to folate or B12 deficiencies. More advanced cases may present with evidence of myelodysplasia.

  • Aplastic
    Clinical suspicion: Anemia with thrombocytopenia or pancytopenia with reticulocytopenia. Bone marrow aspirate often shows dry tap.

  • Anemia of chronic diseases.

Increased MCV

Is almost always due to

  • B12 or

  • folate deficiencies.

Clinical suspicion: Macrocytic anemia with absolute reticulocytopenia.

Diagnosis: Serum B12 and RBC folate are measured.

If results of above are equivocal then both methylmalonic acid and homocysteine are measured. Both are elevated in B12 deficiency whilst only homocysteine is elevated in folate deficiency.

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