What does the gradual increase in my mother's MCV and MCH indicate?

Question

Hi doctor,

My mother, who is 60 years old, is currently under treatment for hypothyroidism, hypertension and stage 2 osteoarthritis of knee joints. She is currently on the following medicines: Eltroxin 50 mcg, Olmezest 20 mg, Gemcal D3 and E-cod Plus. I have attached a copy of her recent kidney, thyroid, lipid and hemogram reports. Her Hb is reported as 10.8 with the blood smear report mentioning RBCs mild anisopoikilocytosis. Predominantly macrocytic normochromic with macroovalocytes. Platelets appear mildly reduced in smear. Macroplatelets are seen. Following this, our doctor advised to test ferritin, B12 and folic acid. It came as normal, although the samples were provided after mild breakfast.

Another thing I wanted to mention is that last year also, she was diagnosed with mild anemia with Hb 10.6 and ferritin 39. However, following Orofer XT for three months her Hb was improved to 12.4. After that due to gastritis issues, the doctor had advised her to take Orofer XT once a week and it was stopped three months back. At that time, her Hb was 12.0.

Answer 1

Hi,

Welcome to icliniq.com.

Based on your query, my opinion is as follows:

Yes, vitamin B12, folic acid, and iron levels are normal at present.
The present macro ovalocytes and macro platelets are indicative of deficiency. Maybe for a short period due to infection or stress, there was deficiency.
Also, hypothyroidism is one of the common causes of these findings which is macro ovalocytes.
Importantly, we need to test for reticulocyte count. It is indicative of bone marrow functioning. If it keeps increasing, then hemoglobin will improve.
If it is low, then bone marrow evaluation will be necessary. Do get a test for reticulocyte count done.

Answer 2

Hi,

Welcome back to icliniq.com.

Based on your query, my opinion is as follows:

Yes, based on the available report (attachment removed to protect patient identity) gastrointestinal bleeding can be ruled out as the hemoglobin is not too low. If there is any bleeding, platelet would also normally increase. As both are not seen, I do not suspect internal bleeding.
Clinically, it indicates a deficiency at an earlier period. However, it is not significant now as all deficiency values are normal and it will get corrected. There is nothing to be worried about.
It is only 8 lbs and is not significant as the period is long. If within a month she lost 8 lbs without dieting or any attempt at weight loss, then I would be worried. This is a long period and not to be worried about.
Increased MCV (mean corpuscular volume) suggests larger RBCs (red blood cells). Usually, it means macrocytes. There are numerous causes and vitamin B12 or folic acid deficiency is one of them.
There are so many megaloblastic and non-megaloblastic causes including hypothyroidism. Nothing serious enough to be worried about.
Repeat the tests after three months, including reticulocyte count. If it is still increasing, then we shall evaluate other causes.