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Does the mean corpuscular volume help physicians evaluate hospitalized patients with anemia?

Journal of General Internal Medicine volume 5, pages 187–191 (1990)Cite this article

Abstract

The authors analyzed the value of using mean corpuscular volume (MCV) as a guide for selecting tests for further evaluation of anemia in hospitalized patients. Of the 2,082 patients with anemia admitted to the medical service of a teaching hospital over one year, 655 (31%) had further diagnostic tests to evaluate the cause of the anemia. Within this group of 655 patients, 399 (61%) had normal MCVs. Over half the patients with abnormal serum vitamin B12, folate, or ferritin levels, or with low serum iron (Fe) levels with elevated total iron-binding capacity (TIBC), did not have the MCVs expected according to the classification of anemia proposed by Wintrobe. Furthermore, 5% of patients with evidence of iron deficiency had high MCVs, and about 12% of patients with decreased vitamin B12 levels had low MCVs. The MCV was quite specific in identifying patients who had low ferritin levels: specificity was 83%; however, sensitivity was only 48%. The MCV was also specific (88%) for identifying patients who had low Fe with elevated TIBC; however, sensitivity was only 43%. The MCV was poor in identifying patients with abnormalities of serum vitamin B12 and folate levels. In this study the MCV did not provide sufficient diagnostic accuracy to be a useful criterion for the selection of more definitive tests in the evaluation of anemia in hospitalized patients.

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Authors and Affiliations

  1. the Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts

    Susan J. Seward MD & Keith I. Marton MD

  2. the Division of General Medicine, Beth Israel Hospital, and the Center for Clinical Computing, Harvard Medical School, Boston, Massachusetts

    Charles Safran MD

  3. the Division of Hematology-Oncology, Beth Israel Hospital, Boston, Massachusetts

    Stephen H. Robinson MD

  4. the Charles A. Dana Research Institute and the Harvard Thorndike Laboratory of the Beth Israel Hospital, Boston, Massachusetts

    Charles Safran MD & Stephen H. Robinson MD

Authors
  1. Susan J. Seward MD
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  2. Charles Safran MD
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  3. Keith I. Marton MD
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  4. Stephen H. Robinson MD
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Additional information

Supported in part by Grant LM 04260 from the National Library of Medicine and Grant HS04928 from the National Center for Health Services Research.

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Seward, S.J., Safran, C., Marton, K.I. et al. Does the mean corpuscular volume help physicians evaluate hospitalized patients with anemia?. J Gen Intern Med 5, 187–191 (1990). https://doi.org/10.1007/BF02600530

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  • DOI: https://doi.org/10.1007/BF02600530

Key words

  • anemia
  • decision making
  • diagnostic tests
  • mean corpuscular volume