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Blood Report Says RBCs:Mild Anisopoikilocytosis. Predominantly Normocytic Normochromic With Ovalocytes & Macrocytes. Meaning?

Posted on Thu, 24 Oct 2013

Question: Hi My Blood report says : : Alert!!! RBCs:Mild anisopoikilocytosis. Predominantly normocytic normochromic with ovalocytes & macrocytes.

What does this mean ? what do I do ?

TOTAL LEUCOCYTES COUNT 9.01 X 10³ / μL 4.4 - 11.0
NEUTROPHILS 67.8 % 40-80
LYMPHOCYTE PERCENTAGE 27.1 % M:20-40; F:20-40
MONOCYTES 2.6 % 0-10
EOSINOPHILS 2 % 0-6
BASOPHILS 0.2 % 0-1
IMMATURE GRANULOCYTE PERCENTAGE(IG%) 0.3 % Male : 0-0.5 Female: 0-0.4
NEUTROPHILS - ABSOLUTE COUNT 6.11 X 10³ / μL 2.0 - 7.0
LYMPHOCYTES - ABSOLUTE COUNT 2.44 X 10³ / μL 1.00 - 3.00
MONOCYTES - ABSOLUTE COUNT 0.23 X 10³ / μL 0.20 - 1.00
BASOPHILS - ABSOLUTE COUNT 0.02 X 10³ / μL 0.02 - 0.10
EOSINOPHILS - ABSOLUTE COUNT 0.18 X 10³ / μL 0.02 - 0.50
IMMATURE GRANULOCYTES(IG) 0.03 X 10³ / μL 0.03
TOTAL RBC 4.99 X 10^6/μL Male : 4.3-5.9 Female : 3.5-5.0
NUCLEATED RED BLOOD CELLS Nil X 10³ / μL Nil in adults
HEMOGLOBIN 14.1 g/dL Male : 13.3-17.7 Female : 11.7-15.7
HEMATOCRIT(PCV) 47 % Male : 39.8-52.2 Female : 34.9-46.9
MEAN CORPUSCULAR VOLUME(MCV) 101.8 fL 76-100
MEAN CORPUSCULAR HEMOGLOBIN(MCH) 28.3 pq 27.0-33.0
MEAN CORP.HEMO.CONC(MCHC) 27.8 g/dL 33.4-37.0
RED CELL DISTRIBUTION WIDTH - SD(RDW-SD) 57.6 fL 39 - 46
RED CELL DISTRIBUTION WIDTH (RDW-CV) 15.3 % 11.5-14.5
PLATELET DISTRIBUTION WIDTH(PDW) 11.02 fL 9.6-15.2
MEAN PLATELET VOLUME(MPV) 7.6 fL 6.5-12.0
PLATELET COUNT 398 X 10³ / μL 150-400
PLATELET TO LARGE CELL RATIO(PLCR) 23.1 % 19.7 - 42.4
PLATELETCRIT(PCT) 0.39 % 0.19 - 0.39
ERYTHROCYTE SEDIMENTATION RATE (ESR) 7 mm / hr Male : 0-15 Female : 0-20
: Alert!!! RBCs:Mild anisopoikilocytosis. Predominantly normocytic normochromic with ovalocytes &
macrocytes.

Answered by Dr. Sujoy Khan (2 hours later)

Brief Answer:
Exclude Vit B12 deficiency

Detailed Answer:
Hello,
Welcome to Healthcare Magic.

MEAN CORPUSCULAR VOLUME(MCV) 101.8 fL 76-100
RBCs:Mild anisopoikilocytosis. Predominantly normocytic normochromic with ovalocytes & macrocytes
The above report predominantly suggests either:
1. Vit B12 deficiency or folate deficiency
where the red cells are big in size (ovalocytes, macrocytes) and MCV is high.
or
2. Thyroid remains under treated
I note you are on Thyroxine 25mcg, so please ensure fasting TSH, fT4 are checked to ensure the dose of supplementation is correct.

I hope that was useful.
Best Wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sujoy Khan (1 hour later)

Thanks for your revert Doctor :)

My Thyroid Reports are as under
TOTAL TRIIODOTHYRONINE (T3) C.L.I.A 127 ng/dl 60 - 200
TOTAL THYROXINE (T4) C.L.I.A 12.7 μg/dl 4.5 - 12.0
THYROID STIMULATING HORMONE (TSH) C.L.I.A 5.67 μIU/ml 0.30 - 5.5

Do I need any treatment for Vit B12 Defi or taking Thyroxine should be good enough , kindly suggest

Answered by Dr. Sujoy Khan (7 hours later)

Brief Answer:
You need to get the B12 level done first

Detailed Answer:
Hello,
The thyroid reports are not entirely clear cut;
the TSH is high, as well as the T4 and is mainly a false high due to total T4 being tested.
You need the free T4 levels done (fT4) and if that is low, you need to increase the thyroxine dose, which will be likely given the high TSH.
Also when you get the next TSH, fT4 done do that on a 12-hr fasting sample without taking the morning thyroid tabs

Please get B12, folic acid levels tested before starting any treatment.

Best Wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar