From the Guidelines
The patient's CBC results indicate microcytic anemia with elevated red blood cell count, suggesting either polycythemia vera or secondary polycythemia with concurrent iron deficiency or thalassemia trait, and further evaluation is necessary to determine the underlying cause. The patient has a high RBC count (6.36 x10^6/μL), normal hemoglobin (16.0 g/dL), and high-normal hematocrit (51.0%) 1. The red blood cell indices show microcytosis with low MCH (25.2 pg) and low MCHC (31.4 g/dL), along with an elevated RDW (16.5%) 1. This pattern is consistent with either polycythemia vera or secondary polycythemia with concurrent iron deficiency or thalassemia trait. Some key points to consider in the evaluation of anemia include:
- The morphologic approach to evaluating anemia, which characterizes anemia based on the mean corpuscular volume (MCV) 1
- The kinetic approach to evaluating anemia, which focuses on the underlying mechanism of anemia, distinguishing among the production, destruction, and loss of RBCs 1
- The importance of serum iron studies, including ferritin, iron, and TIBC, in evaluating iron deficiency 1
- The role of hemoglobin electrophoresis in ruling out thalassemia 1
- The potential for polycythemia vera, which may require JAK2 mutation testing 1 Further evaluation should include:
- Serum iron studies (ferritin, iron, TIBC) to assess for iron deficiency 1
- Hemoglobin electrophoresis to rule out thalassemia 1
- Possibly JAK2 mutation testing if polycythemia vera is suspected 1
- Oxygen saturation to rule out hypoxemia as a cause of secondary polycythemia 1 The patient should be referred to a hematologist for further evaluation and management of the underlying cause of these abnormalities 1.
From the Research
Blood Test Results
The provided blood test results show the following values:
- WBC: 8.1 (normal range: 3.4-10.8 x10E3/uL)
- RBC: 6.36 (high, normal range: 4.14-5.80 x10E6/uL)
- Hemoglobin: 16.0 (normal range: 13.0-17.7 g/dL)
- Hematocrit: 51.0 (normal range: 37.5-51.0%)
- MCV: 80 (normal range: 79-97 fL)
- MCH: 25.2 (low, normal range: 26.6-33.0 pg)
- MCHC: 31.4 (low, normal range: 31.5-35.7 g/dL)
- RDW: 16.5 (high, normal range: 11.6-15.4%)
- Platelets: 346 (normal range: 150-450 x10E3/uL)
Possible Causes of Abnormal Values
The abnormal values in the blood test results may indicate the following conditions:
- High RBC count: may be caused by dehydration, polycythemia vera, or other conditions 2
- Low MCH and MCHC: may be caused by iron deficiency anemia, thalassemia, or other conditions 2, 3
- High RDW: may be caused by iron deficiency anemia, vitamin B12 deficiency, or other conditions 2, 4
Diagnostic Tests
To further diagnose the cause of the abnormal values, the following tests may be ordered:
- Iron panel (ferritin, iron levels, total iron-binding capacity, transferrin saturation) to diagnose iron deficiency anemia 2, 5
- Vitamin B12 and folate levels to diagnose vitamin B12 or folate deficiency anemia 2, 3, 5
- Reticulocyte count to evaluate bone marrow function and diagnose anemia 6, 4, 5
- Peripheral blood smear to evaluate red blood cell morphology and diagnose conditions such as anisocytosis or poikilocytosis 6, 5