Macrocytosis (folate/B12 deficiencies) and microcytosis (iron deficiency)

Found an interesting article from a user of another FB group (UMN), describing his journey and his fight with UK’s healthcare system.

He eventually discovered that the device that does blood count, fails to report combined microcytosis (iron deficiency) and macrocytosis (b12/folate deficiency), providing an average normal MCV value instead.

TLDR: Normal blood count numbers don’t mean all is good - the devil in details and it’s possible to have deficiencies that hide each other.

In February 2021, I wrote a detailed email to the Medicines and Healthcare products Regulatory Agency (MHRA) regarding the Sysmex XE-2100 Differential Analyser - Automated Cell Counter because it was failing to flag up a situation whereby a patient had both a macrocytosis (folate and/or B12 deficiencies) and a microcytosis (iron deficiency) but the mean corpuscular volume (MCV) was normal and the mean corpuscular haemoglobin (MCH) was over the top of the range.

Normally, the MCV and MCH should track one another, i.e. if the MCV was normal the MCH should be normal, if raised, both should be raised. When the MCV is normal and the MCH is over the top-of-the-range, logically, this should indicate a possible combined macrocytosis and microcytosis.

Automated Cell Counters like the Sysmex XE-2100 should be able to flag up the presence of macrocytosis and microcytosis even when the MCV is normal, see page 182.

Unfortunately, despite obtaining the full print out from this analyser, there were no flags indicating the presence of macrocytosis or microcytosis anywhere. The failure of the analyser to flag up the microcytosis, which I believe it should have, was what I was complaining about. @@REF_PLACEHOLDER_1@@