What is the treatment for elevated Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH)?

From the Guidelines

Elevated MCV and MCH are typically indicative of iron deficiency, and treatment should focus on addressing the underlying cause, with iron supplementation being the primary approach, as recommended by the British Society of Gastroenterology guidelines 1. To treat elevated MCV and MCH, the following steps can be taken:

• Check serum ferritin levels, with a level of <15 μg/L being highly specific for iron deficiency 1
• Consider iron supplementation, with the goal of increasing serum ferritin levels and improving MCV and MCH values
• If serum ferritin levels are between 15-30 μg/L, consider iron deficiency as a possible cause, and further investigation may be necessary 1
• In cases where iron deficiency is suspected, but serum ferritin levels are normal or elevated, consider the possibility of an inflammatory disease process, and adjust the diagnostic approach accordingly 1
• Hb electrophoresis may be recommended in cases with microcytosis and normal iron studies, particularly if there is an appropriate ethnic background, to rule out haemoglobinopathies 1 It is essential to note that the treatment approach may vary depending on the underlying cause of the elevated MCV and MCH, and a thorough diagnostic evaluation is necessary to determine the best course of treatment.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Pernicious Anemia Parenteral vitamin B12 is the recommended treatment and will be required for the remainder of the patient's life. A dose of 100 mcg daily for 6 or 7 days should be administered by intramuscular or deep subcutaneous injection. If there is clinical improvement and if a reticulocyte response is observed, the same amount may be given on alternate days for seven doses, then every 3 to 4 days for another 2 to 3 weeks. By this time hematologic values should have become normal This regimen should be followed by 100 mcg monthly for life. Folic acid should be administered concomitantly if needed.

To treat elevated Mcv (Mean Corpuscular Volume) and Mch (Mean Corpuscular Hemoglobin) values, which are indicative of macrocytic anemia, parenteral vitamin B12 is the recommended treatment. The treatment regimen consists of:

• An initial dose of 100 mcg daily for 6 or 7 days administered by intramuscular or deep subcutaneous injection
• Followed by 100 mcg on alternate days for seven doses, then every 3 to 4 days for another 2 to 3 weeks
• Maintenance treatment with 100 mcg monthly for life Folic acid should also be administered concomitantly if needed 2.

From the Research

Elevated MCV and MCH: Causes and Treatment

Elevated Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) are indicators of macrocytic anemia, which can be caused by various factors including vitamin B12 and folate deficiency.

• The diagnosis of macrocytic anemia involves identifying the underlying cause, which can be megaloblastic or nonmegaloblastic 3.
• Megaloblastic anemia is caused by deficiency or impaired utilization of vitamin B12 and/or folate, whereas nonmegaloblastic macrocytic anemia is caused by various diseases such as myelodysplastic syndrome (MDS), liver dysfunction, alcoholism, hypothyroidism, certain drugs, and less commonly inherited disorders of DNA synthesis 3.
• Treatment of macrocytic anemia depends on the underlying cause and may involve vitamin B12 and/or folate supplementation 4, 5.

Vitamin B12 and Folate Deficiency

Vitamin B12 and folate deficiency are common causes of macrocytic anemia, particularly in older adults.

• Vitamin B12 deficiency can be caused by low dietary intake, malabsorption, or genetic polymorphisms in transcobalamins 6.
• Folate deficiency can be caused by low intake of sources rich in the vitamin, such as legumes and green leafy vegetables, as well as lactation and alcoholism 6.
• Excess folic acid supplementation can exacerbate vitamin B12 deficiency, particularly in individuals with pernicious anemia or epilepsy 7.

Treatment of Vitamin B12 and Folate Deficiency

Treatment of vitamin B12 and folate deficiency involves supplementation with the deficient vitamin.

• Vitamin B12 supplementation can be given orally or intramuscularly, depending on the severity of the deficiency and the individual's ability to absorb the vitamin 5.
• Folate supplementation is typically given orally, and high doses may be necessary to correct deficiency 4.
• It is essential to diagnose and treat vitamin B12 deficiency promptly, as delayed treatment can lead to irreversible neurological damage 4, 7.