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A 62-year-old female with a h istory of discoid lupus presen ts complaining of Fatigue. Physical exami nation reveals pal lor and tachycardia. There is no evidence of lymphade-nopathy or hepatosplenomegaly. Laboratory workup reveals hemoglobin of 6.2 g/dL. mean corpuscular volume (MCV) of 1 22 FL. leukocyte count of 1 6.800/ ,ul. and platelet count of 380,000/ ,uL. Peripheral smear is shown below.
What is the most likely etiology for the elevated MCV?
- Vitamin B12 deficiency
- Folete deficiency
- Reticulocytosis
- Myelodysplastic syndrome
- Hypothyroidism
Medicine
C. Peripheral blood smear reveals increased number of large red blood cells (RBC) with basophilic staining (polychromasia), characteristic of reticulocytes. Given that reticulocytes have higher MCV values than mature RBCs (103-126 fL), the most likely etiology underlying the elevated MCV is reticulocytosis.
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