Immunosuppression 1 year Post Liver Transplantation

Dear Ask The Doctor: My daughter is 1 year post liver transplant I just got a copy of her labs and there were some I were wondering about! Her prograf level was high and her EBV was at 175,000. Anisocytosis- Slight Microcytosis- Moderate (Im worried about that) Whats it mean? RBC was low Hematocrit was low MCH low

Dear Shawn: Prograf level refers to Tacrolimus level which is one of the drugs used for immunosuppression post transplant. The dose of Tacrolimus is tailored according to blood levels. EBV refers to Epstein Barr Virus and this level is monitoring activity of this virus, as post transplant it can be associated with lymphoproliferative disorders in patients on immunosuppression therapy. Anistocytosis means that the red blood cells present on blood film are of unequal size. Microcytosis means that the red blood cells present are small compared to a normal RBC. In the presence of low red blood cells (RBC), haematocrit and low Mean corpuscular haemoglobin (MCH), this most likely represents microcytic hypochromic anaemia. If you have any further concerns I advise contacting your daughters specialist physician.