Interpretation

The normal reference range is typically 80-100 fL[1].

[edit]High

In presence of hemolytic anaemia, presence of reticulocytes can increase MCV. In pernicious

anemia (macrocytic), MCV can range up to 150 femtolitres. An elevated MCV is also associated
with alcoholism[2] (as are an elevated GGT and a ratio of AST:ALT of 2:1). Vitamin B12and/or Folic Acid
deficiency has also been associated with macrocytic anemia (high MCV numbers).

Mean Corpuscular Hemoglobin (MCH) Normal Range: 26-34 pg (picograms/cell)

The mean corpuscular hemoglobin, or "mean cell hemoglobin" (MCH), is the average mass of
hemoglobin per red blood cell in a sample of blood. It is reported as part of a standard complete blood
count.

It is diminished in microcytic anemias and increased in macrocytic anemias.

It is calculated by dividing the total mass of hemoglobin by the number of red blood cells in a volume
of blood.

MCH=Hgb/RBC

reference: http://en.wikipedia.org/wiki/Mean_corpuscular_hemoglobin
What does the test result mean?
INCREASED HCT
Decreased hematocrit indicates anemia, such as that caused by iron deficiency or other deficiencies. Further testing
may be necessary to determine the exact cause of the anemia.
Other conditions that can result in a low hematocrit include vitamin or mineral deficiencies, recent
bleeding, cirrhosis of the liver, and malignancies.
The most common cause of increased hematocrit is dehydration, and with adequate fluid intake, the hematocrit
returns to normal. However, it may reflect a condition called polycythemia vera—that is, when a person has more
than the normal number of red blood cells. This can be due to a problem with the bone marrow or, more commonly,
as compensation for inadequate lung function (the bone marrow manufactures more red blood cells in order to carry
enough oxygen throughout your body). Anytime a hematocrit is persistently high, the cause should be determined in
consultation with a doctor.

With regard to transfusions, this is normally not considered for otherwise healthy persons as long as the hemoglobin
level is above 8 grams per deciliter or the hematocrit is above 24%.

With epithelial cells

Large numbers of squamous epithelial cells in urinalysis may also be due to contamination of the urine.
The most common causes of epithelial cells in urine are infections, inflammation and malignancies.
However, your health care provider can read the results of urinalysis and diagnose the problem.
Hirschsprung's disease, or congenital aganglionic megacolon, involves anenlargement of the colon,
caused by bowel obstruction resulting from an aganglionicsection of bowel (the normal enteric nerves are
absent) that starts at the anus and progresses upwards. The length of bowel that is affected varies but
seldom stretches for more than about 30 cm.

Clinical features
With an incidence of 1/5000 births, the most cited feature is absence of ganglion cells: notably in males,
75% have none in the recto-sigmoid, and 8% with none in the entire colon. The enlarged section of the
bowel is found proximally, while the narrowed, aganglionic section is found distally; the absence of
ganglion cells results in a persistent over-stimulation of nerves within the affected region, resulting in
contraction.

1) Delayed passage of meconium.

2) Abdominal distension.

3) Constipation.

[edit]Diagnosis

Suspect Hirschsprung's in a baby who has not passed meconium within 48 hours of delivery. (Recall that
90% of babies pass their first meconium within 24 hours, and the next 9% within 48 hours.) Definitive
diagnosis is made by suction biopsy of the distally narrowed segment.

[edit]Treatment

Treatment of Hirschsprung's disease consists of surgical removal (resection) of the abnormal section of
the colon, followed by reanastomosis. There used to be two steps typically used to achieve this goal.

 The first stage used to be a colostomy. When a colostomy is performed, the large intestine is cut
and an opening is made through the abdomen. This allows bowel contents to be discharged into a
bag.
 Later, when the child’s weight, age, and condition is right, a pull-through procedure is performed.

Orvar Swenson, the same man who discovered the cause of Hirschsprung’s, first performed it in 1948
(Swenson 839). The pull-through procedure repairs the colon by connecting the functioning portion of the
bowel to the anus. The pull through procedure is the typical method for treating Hirschsprung’s in younger
patients. Swenson devised the original procedure, but the pull-through surgery has been modified many
times. Sawin, an expert in pull-through surgery, notes that, "Although there are about five different pull-
through procedures, they are all more or less equally effective in treating the disorder."
The Swenson, Soave, Duhamel, and Boley procedures all vary slightly from each other with equivalent
results (Sawin).

 The Swenson procedure leaves a small portion of the diseased bowel.

 The Soave procedure leaves the outer wall of the colon unaltered.
 The Boley procedure is just a small modification of the Soave procedure.
 The Duhamel procedure uses a surgical stapler to connect the good and bad bowel. The front of
the bowel will end up with no cells, but the back will be healthy (Sawin).

Current practice is to perform the procedure without a colostomy. Sawin notes that “Pull-through
procedures used to require a colostomy, but with increased awareness among doctors and parents about
the symptoms of Hirschsprung’s and with early diagnosis, doctors can keep the colon clean and perform
the pull-through procedure without a colostomy”. In general, “85 percent of patients that have the pull-
through surgery live normal lives afterwards. The other 15 percent have to take a laxative for the rest of
their lives”.

Of those 15 % of children who do not obtain full control, various other treatments are available. If
constipation is the problem then usually laxatives or a high fiber diet will overcome the problem. If lack of
control is the problem then a stoma may be necessary. The ACE or Malone is also an answer. This is
where a tube goes through the abdominal wall to the appendix, or if available, to the colon. Then once a
day the bowel is flushed. Children as young as 6 do fine with administering this on their own.

If the affected portion of the lower intestine is restricted to the lower portion of the rectum, other surgical
procedures, such as the posterior rectal myectomy, can be performed.