Differential Diagnosis for Elevated Hgb, Hct, MCV, and MCH
Single Most Likely Diagnosis
- Dehydration: This is a common cause of elevated hemoglobin (Hgb), hematocrit (Hct), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) due to a decrease in plasma volume, which concentrates the blood cells.
Other Likely Diagnoses
- Polycythemia Vera: A myeloproliferative disorder that leads to an overproduction of red blood cells, white blood cells, and platelets, resulting in elevated Hgb, Hct, MCV, and MCH.
- Chronic Hypoxia: Conditions such as chronic obstructive pulmonary disease (COPD) or living at high altitudes can lead to increased erythropoietin production, stimulating red blood cell production and elevating Hgb, Hct, MCV, and MCH.
- Testosterone Replacement Therapy: Exogenous testosterone can stimulate erythropoiesis, leading to increased red blood cell production and elevated Hgb, Hct, MCV, and MCH.
Do Not Miss Diagnoses
- Carbon Monoxide Poisoning: Although less common, carbon monoxide poisoning can cause an increase in Hgb and Hct due to the increased affinity of hemoglobin for carbon monoxide, which can lead to tissue hypoxia.
- Erythropoietin-Producing Tumors: Rare tumors that produce erythropoietin, such as renal cell carcinoma or hepatocellular carcinoma, can lead to increased red blood cell production and elevated Hgb, Hct, MCV, and MCH.
Rare Diagnoses
- Congenital Methemoglobinemia: A rare genetic disorder that affects the production of hemoglobin, leading to elevated MCH and MCV.
- Di Guglielmo's Disease: A rare myeloproliferative disorder characterized by an increase in immature red blood cells, which can lead to elevated Hgb, Hct, MCV, and MCH.