With the advent of electronic particle counters of the Coulter S type the mean cell volume (MCV) has become an integral and useful feature of the red cell profile. Abnormally high values, often of minor degree, are particularly common but their precise clinical significance may be difficult to establish. This study defines the normal range and determines the incidence and distribution of the high MCV in routine hospital practice. Two hundred consecutive adult patients with an MCV of 100 fl or more were identified from the Coulter S analysis of 6542 blood samples and the underlying cause was established in 80%. Some of the clinical and economic implications of these findings are presented and briefly discussed.