In a patient with hemoglobin 14.5 g/dL, hematocrit 48.2 %, platelet count 427 ×10⁹/L, mean corpuscular volume 98.2 fL, mean corpuscular hemoglobin concentration 30.1 g/dL, red cell distribution width 14.2 % and mean platelet volume 8.4 fL, what is the differential diagnosis and recommended work‑up and management?

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Laboratory Interpretation and Clinical Assessment

These laboratory values are entirely normal and require no intervention or further workup. 1, 2

Normal Reference Ranges and Interpretation

Your complete blood count shows:

  • Hemoglobin 14.5 g/dL and hematocrit 48.2% fall within the normal range for adult males (hemoglobin 13.5–17.5 g/dL, hematocrit 42–54%) and are at the upper end of normal for post-menopausal females (hemoglobin 12.0–16.0 g/dL, hematocrit 36–48%). 2

  • Platelet count 427 ×10⁹/L is within the normal range (150–450 ×10⁹/L) and does not meet criteria for thrombocytosis, which requires sustained elevation ≥450 ×10⁹/L. 3

  • MCV 98.2 fL is at the upper end of normal (80–100 fL) but does not constitute macrocytosis, which is defined as MCV >100 fL. 4, 5

  • MCHC 30.1 g/dL is within the normal range (32–36 g/dL) and does not indicate hypochromia, which would suggest iron deficiency. 1

  • RDW 14.2% is within the normal range (11.5–14.5%) and indicates a homogeneous red cell population without significant anisocytosis. 6, 7

  • MPV 8.4 fL is within the normal range (7.5–11.5 fL) and provides no evidence of platelet dysfunction or myeloproliferative disorder. 3

Why No Further Testing Is Needed

The combination of normal hemoglobin, normal MCV, normal MCHC, and normal RDW effectively excludes all clinically significant hematologic disorders. 1, 6

  • Normal MCHC rules out iron deficiency anemia, which would present with low MCHC (<30 g/dL) and typically low MCH. 1

  • Normal MCV with normal RDW excludes both microcytic disorders (iron deficiency, thalassemia) and macrocytic disorders (B12/folate deficiency, myelodysplasia). 4, 5, 6

  • The platelet count of 427 ×10⁹/L does not meet the threshold for essential thrombocythemia (≥450 ×10⁹/L sustained) and is commonly seen as a normal variant or mild reactive thrombocytosis. 3

  • Normal RDW indicates uniform red cell size distribution, which argues strongly against mixed nutritional deficiencies, hemolysis, or early myelodysplastic syndrome. 5, 6, 7

Common Pitfalls to Avoid

Do not order iron studies, B12/folate levels, or JAK2 mutation testing based on these normal values. 1, 2 The hemoglobin and hematocrit do not meet criteria for erythrocytosis (>18.5 g/dL men, >16.5 g/dL women), and the platelet count does not meet criteria for thrombocytosis. 3, 2

Do not interpret the platelet count of 427 ×10⁹/L as pathologic thrombocytosis. 3 Essential thrombocythemia requires sustained platelet elevation ≥450 ×10⁹/L, and this value is within the normal range for many laboratories.

Do not pursue polycythemia vera workup. 2 The hemoglobin 14.5 g/dL and hematocrit 48.2% fall well below the WHO diagnostic thresholds for polycythemia vera (hemoglobin >18.5 g/dL men or >16.5 g/dL women; hematocrit >52% men or >48% women). 3, 2

Recommended Management

Routine follow-up with repeat complete blood count only if clinically indicated by new symptoms (fatigue, bleeding, thrombosis, splenomegaly). 2 No specific interval monitoring is required for these normal values.

References

Guideline

Diagnosis and Management of Iron Deficiency Anemia

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Guideline

Assessment Protocol for Incidental Erythrocytosis

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Management of Macrocytic Anemia in Vegetarian Patients

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Research

The red blood cell distribution width.

The Journal of emergency medicine, 1991

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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