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Pediatrics/does this 8 months old child have macrocytic anaemia or not?

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Question
Hi Doctor. I have a blood count result of an eight months old child diagnosed with skin sepsis, underweight and malnutrition. The laboratory scientist who did the analysis reported macrocytic anaemia but the red cell indices and haemoglobin values doesn't show that. pls can u tell me if this child is anaemic and also the type of anaemia if yes. Here are some of the results:
Hb 11.0g/dl
Hct 39%,
MCV 70.9fl
MCH 19.9pg
MCHC 28.16g/dl
RBC 5.5 x 10^12/L
WBC total 17.6 x 10^9/L
Plt 281 x 10^9/L
RDW 23.1%
Granulocytes 4.5%
Lymphocytes 11.6%

He claims to have seen macrocytes, anisocytosis and poikilocytes on the blood smear. please help me make sense of the CBC result. thank you

Answer
The white cell count is elevated although I am not sure the granulocyte and lymphocyte counts are percentages or absolute values as 11.6 + 4.5 is only 16.1% so I am not sure what the other 85.9% of the white cells are.
The Hb is not particularly low so I am not sure there is anaemia but the MCV, MCHC and MCH are all low so if there was an anaemia it would be "microcytic". This could be due to iron deficiency or chronic infection.
I cannot comment on the film.

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Dr Graham Smith

Expertise

I am accredited in general paediatrics and paediatric nephrology and and am happy to answer questions on both topics. It is not possible or safe to assess acutely sick children through this medium. Such children should be taken to their own doctor, where a full history can be taken and an examination carried out.

Experience

I have been a consultant paediatrician and paediatric nephrologist for 13 years. I have been involved in paediatrics for 22 years.

Organizations
Royal College of Paediatrics and Child Health
British Association for Paediatric Nephrology
European Society for Paediatric Nephrology
International Pediatric Nephrology Association

Publications
Archives of Disease in Childhood
British Medical Journal
Pediatric Nephrology
Current Paediatrics
Nephrology, Dialysis and Transplantation
Nephrology and Urology

Education/Credentials
MA (Cantab)
MB BS (London)
MRCP
FRCPCH

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