The term macrocytosis refers to a blood condition in which red blood cells (RBC) are larger than normal. Macrocytosis is reported in terms of mean corpuscular volume (MCV). Normal MCV values range from 80 to 100 femtoliters (fl) and vary by age and reference laboratory. 1 MCV is calculated according to the following formula:Macrocytosis can be identified by reviewing peripheral blood smears and/or by automated RBC indices. The peripheral blood smear is more sensitive than RBC indices for identifying early macrocytic changes because the MCV represents the mean of the distribution curve and is insensitive to the presence of small numbers of macrocytes. 2 However, compared to the peripheral blood smear, MCV may underestimate macrocytosis in over 30% of cases. 3 Although determination of the MCV by automated blood cell counter is rarely inaccurate, hyperglycemia, marked leukocytosis and cold agglutinins may result in false elevations of the MCV. [4][5][6] Moreover, partial occlusion of the instrument aperture and/or leaving the blood sample at room temperature for several hours may also result in false elevations of the MCV value. Clinical SignificanceMacrocytosis is a relatively common finding in the era of automated blood cell counters, with prevalence estimates ranging from 1.7% to 3.6%. 3,7,8 Its significance tends to be underestimated by physicians, since about 60% of patients present without associated anemia, 8 unless there are other accompanying abnormalities noted.No complications arise from macrocytosis itself as an isolated finding. However, its identification can provide important information regarding the presence of an underlying disease state. Thus, in the appropriate clinical setting, MCV values above the upper limit of normal or those that differ significantly from the patient's baseline values may require further clinical and laboratory assessment to determine the underlying cause of the macrocytosis. 9

Our analysis revealed cecal intubation and documentation rates that meet current guidelines, and identified factors that may cause substantial variance in these rates depending on the nature of the practice. The present analysis confirms that computerized databases can be used to assess individual and group cecal intubation and documentation rates on an annual basis, and to make these data available to the public.

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Recipients of hemodialysis for end-stage renal disease have a higher prevalence of hepatitis C virus (HCV) infection relative to the general U.S. population. However, the natural course of HCV infection in patients with renal failure, including African-Americans and Caucasian-Americans, is not well known. We compared the degree of liver inflammation and fibrosis in patients with HCV infection, with and without end-stage renal disease. This was a cross-sectional study of 156 HCV patients with end stage renal disease (130 African Americans and 26 Caucasian Americans) with a liver biopsy between 1992 and 2005. The control group consisted of 138 patients (50 African Americans) with HCV infections and a serum creatinine less than 1.5 mg/dL with a liver biopsy between 1995 and 1998. Specimens were graded for inflammation and fibrosis using Knodell Histological Activity Index. Compared to patients without renal impairment, HCV patients with renal failure were older and more likely to be African American. Patients with renal impairment had lower mean serum transaminases, a higher mean serum alkaline phosphatase levels (all p<0.0001) and less hepatic necro-inflammation (Knodell Inflamation score -I, II and III; p<0.05) and fibrosis (Knodel fibrosis >4; p<0.0001). There were no racial differences in serum liver chemistry and histology scores among patients with renal failure. In a multivariate analysis, younger age, end stage renal disease, African American race, and a lower serum alkaline phosphatase were associated with lower odds for advanced liver fibrosis. Thus HCV patients with end stage renal disease had a lower degree of hepatic inflammation and fibrosis compared to those without renal disease, independent of race.