Which of the following is decreased in megaloblastic anemia?
a. Reticulocyte production index (RPI)
b. MCV
c. Lactic dehydrogenase (LD)
d. Bilirubin
ANS: A
Because ineffective erythropoiesis occurs in the megaloblastic anemias, the RPI is decreased and the MCV is increased—the anemia is macrocytic. Intramedullary cell death occurs in ineffective erythropoiesis, and this leads to both an increased LD (released from dying cells) and increased bilirubin (increased breakdown of hemoglobin).
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