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Vitamin B12 deficiency: One of the most common causes of high MCV is a deficiency in vitamin B12. This can lead to a condition known as megaloblastic anemia, where red blood cells are larger than normal. Folate deficiency: Similar to vitamin B12 deficiency, low levels of folate can also cause high MCV and megaloblastic anemia. Folate is an essential nutrient for proper red blood cell production. Alcohol abuse: Chronic alcohol abuse can impair the body's ability to absorb and utilize vitamin B12 and folate, leading to elevated MCV levels. Liver disease: Liver diseases such as alcoholic liver disease, cirrhosis, or hepatitis can disrupt the synthesis of red blood cells, resulting in a higher than normal MCV. Hypothyroidism: Underactive thyroid gland (hypothyroidism) can contribute to high MCV levels due to the decrease in red blood cell production and impaired maturation. Medications: Certain drugs, such as anti-seizure medications, may interfere with the normal blood cell production process, leading to an increased MCV. Bone marrow disorders: Conditions such as myelodysplastic syndrome (MDS) or certain types of leukemia can affect the functioning of the bone marrow, leading to abnormal red blood cell production and elevated MCV levels.