Differential Diagnosis for Mild Decrease in MCV and MCHC

• Single most likely diagnosis:
  • Iron deficiency anemia: This is the most common cause of a mild decrease in MCV (Mean Corpuscular Volume) and MCHC (Mean Corpuscular Hemoglobin Concentration), as iron is essential for hemoglobin production and its deficiency leads to smaller, paler red blood cells.
• Other Likely diagnoses:
  • Thalassemia trait: This genetic disorder affects the production of hemoglobin, leading to smaller red blood cells (low MCV) and often a mild decrease in MCHC due to the imbalance in hemoglobin chain production.
  • Anisocytosis (variation in red blood cell size): While not a specific disease, the presence of anisocytosis can lead to a mild decrease in MCV and MCHC due to the variability in cell size and hemoglobin content.
  • Chronic disease: Chronic diseases, such as chronic kidney disease or chronic infections, can lead to a mild decrease in MCV and MCHC due to the body's response to the disease, including changes in iron metabolism and erythropoiesis.
• Do Not Miss diagnoses:
  • Sideroblastic anemia: A group of disorders characterized by the accumulation of iron in the mitochondria of red blood cell precursors, leading to impaired hemoglobin synthesis. It's crucial to diagnose this condition due to its potential association with myelodysplastic syndromes and other serious health implications.
  • Hemoglobinopathies (other than thalassemia): Certain hemoglobinopathies can cause changes in red blood cell indices, including MCV and MCHC, and are critical to diagnose due to their potential impact on health and the need for specific management.
• Rare diagnoses:
  • Copper deficiency: Similar to iron, copper is essential for the production of hemoglobin and connective tissues. A deficiency can lead to anemia with changes in MCV and MCHC, although this is much rarer than iron deficiency.
  • Vitamin deficiency (e.g., vitamin B6 deficiency): Certain vitamin deficiencies can affect erythropoiesis and lead to anemia with alterations in red blood cell indices, including MCV and MCHC, though these are less common causes.