You see a 56-year-old man in your clinic with suspected alcoholic liver disease. Liver function tests reveal a bilirubin of 36 iu/L, AST of 150 iu/L, ALT 75 iu/L and ALP 100 iu/L. Which of the following blood test parameters would support a diagnosis of alcoholic-related liver disease?
1.Normal mean cell volume (MCV)
2.Low MCV
3.Normal mean cell haemoglobin (MCH)
4.Low MCH
5.Raised MCV
View explanation
Macrocytosis, i.e. an elevated MCV (>96 fL) of which the causes can be seen in:
• megaloblastic anaemia secondary to vitamin B12 and folic acid deficiency;
• chronic alcoholism and/or alcoholic liver disease (most common causes of all causes of macrocytosis), pregnancy, hypothyroidism, reticulocytosis, aplastic anaemia, myelodysplastic syndromes and can also be caused by drugs that inhibit DNA synthesis (e.g. azathioprine); an elevated MCV would suggest, along with the deranged LFTs, and support a diagnosis of alcoholic liver disease. Therefore answers A–D are incorrect.