Anemia with elevated Mean Corpuscular Volume

Normal Blood Smear

Normal Liver Function

Tests

Abnormal Liver

Function Tests

Rule out Reticulocytosis

• Myelodysplastic Syndromes

• Rule out B12 and Folate

Deficiency

• Liver Disease

Oval Macrocytes

Hypersegmented

Neutrophils

RBCs in Rouleaux

Formation

Dysplastic

Macrocytosis Target

Cells Normal WBCs

• Multiple Myeloma

• Drugs

Low Serum B12

Antibody Testing

Low RBC Folate

Anti-IF Antibodies

Present

Anti-IF Antibodies Not

Present

• Pernicious Anemia • Small Bowel Disorder

• Pancreatic Disease

• Parasites

• Pernicious Anemia

• Dietary Deficiency

• Malabsorption

• Increased requirement (e.g.

Pregnancy)