Differential Diagnosis for High MCV and High Platelets with Otherwise Normal CBC
Single Most Likely Diagnosis
- Vitamin B12 or Folate Deficiency: This condition often presents with macrocytic anemia (high MCV) and can also cause an increase in platelet count as a compensatory mechanism. The body may produce more platelets in response to the deficiency.
Other Likely Diagnoses
- Alcohol Abuse: Chronic alcohol consumption can lead to macrocytosis (high MCV) due to the toxic effects of alcohol on bone marrow. Additionally, alcohol can cause an increase in platelet count.
- Chronic Liver Disease: Liver disease can lead to macrocytosis due to impaired liver function and altered lipid metabolism. It can also cause thrombocytosis (high platelet count) due to increased production of thrombopoietin.
- Hypothyroidism: Some cases of hypothyroidism can present with macrocytic anemia and elevated platelet count, although this is less common.
Do Not Miss Diagnoses
- Myeloproliferative Neoplasms (MPN): Although less likely, MPNs such as essential thrombocythemia or polycythemia vera can present with elevated platelet count and sometimes macrocytosis. Missing this diagnosis could lead to severe complications, including thrombosis.
- Chronic Myeloid Leukemia (CML): CML can cause an increase in platelet count and sometimes macrocytosis. Early diagnosis is crucial for effective treatment.
Rare Diagnoses
- Paroxysmal Nocturnal Hemoglobinuria (PNH): A rare condition characterized by the destruction of red blood cells, which can lead to macrocytosis and sometimes an increase in platelet count.
- Myelodysplastic Syndromes (MDS): A group of disorders caused by poorly formed or dysfunctional blood cells, which can present with macrocytosis and elevated platelet count in some cases.