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Melbourne Haematology is a collective of clinical and laboratory trained specialist haematologists based in Melbourne, dedicated to providing comprehensive management of patients with haematological disorders.
What's new in haematology: clinical and research updates from our haematologists, explained in plain language, plus practice news.
A raised MCV is one of the most common incidental findings on a blood count. Most of the time the cause is simple. Here is how to tell when it might be something more, and what the latest research adds.
Macrocytosis means the red cells are larger than normal, with a mean cell volume (MCV) above 100 fL. It is a common finding, seen in about 2 to 4% of patients in general practice, and most of them are not anaemic.
Red cells become large for a few different reasons. When DNA synthesis is impaired, as in B12 or folate deficiency or with some medicines, the cell keeps growing while nuclear division lags behind, so fewer but larger cells are released. Alcohol and liver disease change the lipid content of the red cell membrane, young red cells (reticulocytes) are naturally larger, and in MDS an abnormal clone of stem cells produces red cells that mature in a disordered way.
Most macrocytosis has a simple, treatable explanation. MDS becomes a real possibility when the MCV is raised in an older patient, no other cause is found, and the blood count is starting to fall: a persistent anaemia, low neutrophils or low platelets.
Alcohol, medicines and B12 or folate deficiency explain most cases, and around one in ten stays unexplained after a standard workup. Macrocytosis is less likely to be serious when:
A raised reticulocyte count (from bleeding or haemolysis) can also push the MCV up, and cold agglutinins can produce a falsely high result.
MDS is mainly a disease of people over 60, and anaemia is its most common first sign. The worry rises when macrocytosis has no clear cause and the blood count starts to fall. Watch for:
In one study of older patients with unexplained macrocytosis, 12% turned out to have MDS, and they were usually clearly anaemic.
A 2025 Dutch study of about 17,600 people aged 60 and over found that an MCV above 100 fL carried around five times the risk of a later blood cancer. That risk was concentrated in people who also had clonal haematopoiesis, acquired mutations in blood stem cells that become more common with age. Among those with macrocytosis, a clone and an abnormal blood count, 13% developed a blood cancer over about 7 years. A high RDW was an even stronger clue than a high MCV.
The 2022 classifications now recognise clonal cytopenia of undetermined significance (CCUS): an unexplained cytopenia with an MDS type mutation, but not enough change in the marrow to call it MDS. Risk scores for these patients include an MCV of 100 fL or more and an RDW of 15% or more. A myeloid gene panel on peripheral blood can now help a haematologist decide who needs a bone marrow biopsy and who can be reassured.
Start with: alcohol and medication history, FBC with film and reticulocyte count, B12 and folate, LFTs including GGT, TSH and EUC. Treat any cause found and repeat the FBC in 2 to 3 months.
Refer if: macrocytosis remains unexplained and there is any persistent cytopenia, counts are falling, the film suggests dysplasia, or the patient has had prior chemotherapy or radiotherapy. Isolated, stable macrocytosis with a normal FBC can usually be watched in general practice.
Seek same day advice for: blasts on the film, a very low neutrophil count with fever, a very low platelet count with bleeding, or severe symptomatic anaemia.
A helpful referral includes: serial FBCs with dates, film reports, B12, folate, LFTs, TSH, reticulocyte count, medications, alcohol intake and any cancer treatment history.
Monoclonal gammopathy of undetermined significance (MGUS) is common. It is found in around 5% of people over 40, and more often with age. Most people with MGUS never develop a blood cancer, but almost all cases of myeloma start as MGUS. So can finding it early make a difference?
The iStopMM study in Iceland is one of the largest studies in myeloma to date. Everyone in Iceland born in 1975 or earlier was invited, and 75,422 adults were screened with a blood test. People found to have MGUS were randomly assigned to one of three groups: not told, standard follow up, or more intensive follow up. The first headline results were published in the Journal of Clinical Oncology in July 2026.
Screening finds myeloma earlier, before damage is done. But we do not yet know if it helps people live longer, so routine screening of healthy people is not recommended. If MGUS is found, risk based follow up and prompt review of any new symptoms remain the key.
This is general information only. If you have questions about MGUS, please talk to your GP or haematologist.
Low iron is one of the most common problems we see, and it is still often missed. New guidelines from the American Society of Hematology (ASH) are set to change that.
Ferritin measures your iron stores. ASH now says a ferritin of 30 µg/L or below means iron deficiency in adults, menstruating women and pregnancy, replacing the old cut-off of 15 µg/L. With symptoms or heavy periods, a ferritin up to 50 µg/L can still mean low iron.
Inflammation, infection, excess weight and fatty liver all raise ferritin and can hide empty iron stores. Iron studies add transferrin saturation (TSAT), which shows how much iron is reaching the bone marrow. ASH recommends checking both.
Low iron is a sign, not a diagnosis. In men and women after menopause, it can point to hidden bowel bleeding or cancer.
Heavy periods can drain iron faster than tablets can replace it. Many women spend years on tablets, putting up with side effects and still feeling exhausted. A 2026 US study asked whether starting with an iron infusion is worth the extra upfront cost. The researchers modelled women with heavy periods and iron deficiency anaemia from age 18 to menopause. Starting with IV iron gave better quality of life than starting with tablets, and was good value for the health system. The result held even with heavier bleeding.
The study was done in the US, with a different infusion product and different costs, so it can’t simply be applied here. But the message is important for Australia too: in women with heavy periods, early IV iron, alongside treating the bleeding, may be better for patients and better value for the health system.
Ask for full iron studies. Treat at 30, think at 50. Find the cause. Consider IV iron early for heavy periods.
Myeloma is one of the most common blood cancers, and it has long been described as treatable but not curable. That may now be changing. At the International Myeloma Society (IMS) annual meeting in Glasgow in September 2026, the IMS and the International Myeloma Working Group presented the first consensus definition of what “cure” means in myeloma.
Under the definition, a patient may be considered cured after five years in complete remission without any myeloma treatment. The five years are counted from the day treatment stops, not from when remission began. Over that period, the patient must have:
Most patients will not meet this bar yet. With older treatments, an estimated 5% to 30% of patients may have been cured, depending on the regimen, age and disease risk. Late relapse can still occur, even after a long remission.
The definition matters now because a new generation of immune therapies is producing deeper and more durable remissions than ever before:
In Australia, these therapies are currently funded only after several earlier treatments have failed. Elranatamab (a bispecific antibody) is PBS-listed from the fourth line of therapy, and cilta-cel (CAR-T) is publicly funded from the fifth line. Clinical trials have already tested these therapies earlier in the disease course and shown deep, durable remissions, but in Australia that earlier use is currently available only through clinical trials.
When referring a patient with confirmed or suspected myeloma, whether at diagnosis or at relapse, consider a haematologist with sub-specialty experience in myeloma who is across the current clinical trial landscape. For many patients, a trial is the only way to access these therapies earlier.
Dr Katherine Cummins is now also consulting at Eastern Haematology and Oncology Group, 9 Lower Plenty Road, Rosanna. Katherine sees patients with a wide range of blood conditions, including abnormal blood counts and disorders of bleeding and clotting. Appointments can be made by phoning 03 9459 5333.
Enlarged lymph nodes (“swollen glands”), especially in the neck, are one of the most common reasons children are brought to the GP. They are usually the body’s normal response to a recent infection such as a cold or sore throat. The Royal Children’s Hospital guideline notes that palpable neck nodes are found in more than a third of otherwise healthy children, and that a well child usually needs only observation and reassurance, not tests.
A study published in Frontiers in Pediatrics in late 2025 looked at 500 children referred to a specialist paediatric haematology and oncology clinic with enlarged nodes. Even in this referred group, nearly nine in ten had simple reactive nodes and a further 7% had an infection. About 6% had a cancer such as lymphoma or leukaemia. Interestingly, node size and location alone did a poor job of separating the serious cases from the rest. The appearance of the node on ultrasound was a far better guide.
In a well child with typical reactive nodes, a planned review in 4 to 6 weeks is usually all that is needed. If nodes persist or any red flags are present, a full blood count with blood film is a sensible first step, and ultrasound can help decide who needs referral. Children with red flags should be discussed with a paediatric team promptly.
This is general information only. If you are worried about your child, please see your GP.
Melbourne Haematology is a collective of clinical and laboratory trained specialist haematologists based in Melbourne, dedicated to providing comprehensive management of patients with haematological disorders.