Why are levels for MCH, MCHC, MCV and MPV tracked for CLL?

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Question from Elisabeth:
Please explain why the levels for MCH, MCHC, MCV and MPV are tracked for CLL.

Answer from Dr. Leclair:  
All CLL physicians follow the classification system that was invented by Kanti Rai several decades ago. One of the big criteria is the presence of anemia. The problem with just watching for that is that, with a 120 days life span, you have to go a long way before you actually get information that is credible about the presence of an anemia. But, early in the process, red cells start to become less perfect and those very small changes can be tracked by alterations in the MCV and MCHC and RDW. Indeed, the earliest sign of some difficulty with the development of red cells is an increasing RDW, and this can be seen months in advance of the actual anemia. So it is possible to act earlier with greater support for the findings. 

Dr. Kai's classification also includes a significant contribution by the platelet number and size. MPV is the average size of the platelets and that can decrease in situations with bleeding, inflammation and iron deficiency while increases in the MPV are seen where more platelets are being used than can be made. In either instance, the change in the MPV is seen months prior to any noticeable change in the count. 

With increasing experience, physicians have come to believe that drops in platelets sufficient to cause bleeding have to be around or less than 50. But if there are three consecutive decreases in a row, this will indicate some issues in the near future. 

Also, there should be no nucleated red cells in the peripheral circulation, so this is a good thing.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Have a question for the experts? Send them to questions@patientpower.info.

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Page last updated on October 5, 2015