From the Guidelines
A mildly elevated MCV of 96 in a healthy patient can be caused by several factors, including vitamin B12 or folate deficiency, alcohol consumption, certain medications, thyroid disorders, and liver disease, as noted in studies such as 1. When evaluating a mildly elevated MCV, it's essential to consider the patient's overall health and other blood count parameters. Some key points to consider include:
- Vitamin B12 or folate deficiency can lead to slightly enlarged red blood cells, even in early stages, as indicated in 1.
- Alcohol consumption, even moderate drinking, can affect red blood cell production and increase MCV values.
- Certain medications, including anticonvulsants (phenytoin, valproic acid), metformin, and some antibiotics, can also increase MCV values, as mentioned in 1.
- Thyroid disorders, particularly hypothyroidism, may elevate MCV slightly.
- Liver disease, even if subclinical, can affect red blood cell membrane composition. Given that an MCV of 96 is just barely above the typical reference range (80-95 fL), it may represent a normal variant rather than pathology, as suggested by 1. If no symptoms are present and other blood count parameters are normal, this mild elevation often requires only routine monitoring rather than immediate intervention, in line with the approach outlined in 1. It's crucial to investigate anaemia with red cell distribution width (RDW), mean corpuscular volume (MCV), reticulocyte count, full blood count (FBC), ferritin, transferrin saturation, and CRP levels, as recommended in 1. Further laboratory tests, such as B12, red cell folic acid, haptoglobin, and lactate dehydrogenase, may be necessary if the cause of anaemia remains unclear, as noted in 1.
From the Research
Possible Causes of Mildly Elevated MCV
- A mildly elevated Mean Corpuscular Volume (MCV) of 96 in a healthy patient can be caused by various factors, including vitamin deficiencies 2, 3, 4
- Vitamin B12 and folate deficiencies are common causes of elevated MCV, as they are essential for the production of red blood cells 3, 4
- Alcoholism can lead to vitamin deficiencies, including folate and vitamin B12, which can cause an elevated MCV 2, 3
- Functional vitamin B12 deficiency can occur in alcoholics, even with normal serum cobalamin levels, and may respond to vitamin B12 treatment 3
- Low folate levels have been linked to depression, and treatment with folic acid may improve response to antidepressants 4
- Vitamin B12 status has also been associated with depression, and high vitamin B12 status may be associated with better treatment outcome 4