If a client has an elevated mean corpuscular volume (MCV), which diagnosis should be considered?

An elevated mean corpuscular volume (MCV) indicates that the red blood cells are larger than normal, which is often associated with macrocytic anemia. One common cause of this is liver disease. The liver is essential for the metabolism of various nutrients, including vitamin B12 and folate, which are critical for red blood cell production. When the liver is compromised, its ability to store and distribute these nutrients can be affected, leading to the production of larger red blood cells, hence an elevated MCV.

In contrast, conditions such as iron deficiency anemia typically result in microcytic (smaller than normal) red blood cells, and hemolytic anemias may lead to a variety of MCV readings depending on the underlying pathology. Lead poisoning can also cause microcytic anemia and may not necessarily correlate with an elevated MCV. Therefore, when encountering an elevated MCV, considering liver disease as a potential diagnosis is quite appropriate.