What is MCH?
Mean corpuscular hemoglobin, or MCH, is the average amount of hemoglobin in one of your red blood cells.
Mean corpuscular hemoglobin (MCH) is part of a complete blood count (CBC) test.
MCH is a useful measurement for understanding how effectively oxygen is being distributed throughout the body. Changes in MCH or other RBC indices may be a sign of a blood disorder called anemia.
What is hemoglobin?
Hemoglobin is the protein contained in red blood cells that is responsible for delivery of oxygen to the tissues. To ensure adequate tissue oxygenation, a sufficient hemoglobin level must be maintained.
What is a complete blood count?
A complete blood count measures various aspects of your blood, including the health of your red blood cells. MCH is one measurement that can shed light on the health of your red blood cells.
The complete blood count is usually required to get an overview of one’s general health. MCH is not measured directly, but calculated based on the hemoglobin value (Hgb), which is the total measure of hemoglobin in the blood; and the RBC, which is the number of red blood cells in the blood. To calculate MCH, the Hgb is divided by RCB, yielding an average amount of hemoglobin per red blood cell.
When and why is a complete blood count performed?
Your healthcare provider might order a complete blood count either as part of a routine check-up or to help diagnose certain conditions.
What can one diagnose with MCH?
Abnormally high or low levels of MCH, as determined by blood testing, can be an indication of a number of problems in the body, ranging from nutrient deficiencies to chronic diseases.
The main condition MCH can help diagnose is anemia. Anemia is a condition that develops when your body produces too few healthy red blood cells. With limited red blood cells, people with anemia don’t get enough oxygen-rich blood throughout their body. The lack of oxygen can make you feel tired and weak.
The MCH test is one of several tests that are used to diagnose and classify different types of anemia.
What is the normal reference range for MCH?
The normal range for MCH is 27 to 31 picograms per cell. Anything below or above that might indicate an underlying health condition.
Women’s MCH may be lower than men’s because of blood loss during menstruation, which can lead to iron deficiency.
Additional note: Even if your MCH is within a normal range, it is still possible to have normochromic anemia. This type of anemia can develop for multiple reasons, including sudden blood loss or kidney failure.
What are other markers of the complete blood count that evaluate red blood cells?
Your MCH value is related to two other values, mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC). Together, MCH, MCV, and MCHC are sometimes referred to as red blood cell indices.
- Mean corpuscular volume (MCV)
- Mean corpuscular hemoglobin concentration (MCHC)
- Red blood cell distribution width (RDW)
What factors can affect your MCH levels?
Various health conditions can affect MCH levels. For example, anemias driven by deficiencies in iron can result in low MCH levels. Certain medical conditions can also lead to low MCH. These include thalassemia, an inherited blood disorder that is caused by defects in the hemoglobin genes.
Individuals may have high MCH levels if they have a deficiency in nutrients such as vitamin B12 or folic acid. Medical conditions, such as alcoholism, liver disease, and bone marrow diseases, can also cause high MCH. Even medications, including metformin and Prilosec (omeprazole), can be associated with elevated MCH values.
|
MCH level |
Elevation |
Meaning |
|
Less than 26 pg per cell |
Low |
Potentially due to iron deficiency, nutrient deficiency, autoimmune disease, cancer, kidney disease, liver disease, blood loss, or thalassemia |
|
27 to 31 pg per cell |
Normal |
Commonly seen in healthy adults |
|
Greater than 33.2 pg per cell |
Elevated |
Potential causes include vitamin B12 or folic acid deficiency, hemolysis, recovery after bleeding or chemotherapy or nutrient replacement, medication side effects, alcohol, liver disease, HIV, bone marrow disease, cancer, hypothyroidism, Down syndrome, copper deficiency, bariatric or other gastrointestinal surgery, kidney disease, congenital heart defects, and lung disease such as chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis |
References:
- Cleveland Clinic. Complete blood count: Test details.
- National Heart Lung and Blood Institute. Blood tests.
- Huang P, Liu C, Li B, et al. Preoperative mean corpuscular hemoglobin affecting long-term outcomes of hepatectomized patients with hepatocellular carcinoma. Mol Clin Oncol. 2016;4(2):229-236. doi:10.3892/mco.2015.705
- Cleveland Clinic. Hemoglobin test.
- MedlinePlus. Hemoglobin test.
- Cleveland Clinic. High hemoglobin count.
- University of Rochester Medical Center. Overview of blood and blood components.
- Complete blood count (CBC). (2018). labtestsonline.org/tests/complete-blood-count-cbc
- Folate-deficiency anemia. (n.d.) hopkinsmedicine.org/healthlibrary/conditions/hematology_and_blood_disorders/anemia_of_folate_deficiency_85,P00089
- Iron-deficiency anemia. (n.d.). hematology.org/Patients/Anemia/Iron-Deficiency.aspx
- Pernicious anemia. (n.d.). nhlbi.nih.gov/health-topics/pernicious-anemia
- Sarma PR. (1990). Chapter 152: Red cell indices. ncbi.nlm.nih.gov/books/NBK260/
- Thalassemia. (2015). rarediseases.info.nih.gov/diseases/7756/thalassemia
- Your guide to anemia. (2011). nhlbi.nih.gov/files/docs/public/blood/anemia-yg.pdf
- National Heart, Lung, and Blood Institute. What is anemia?
- MedlinePlus. Hypochromia
- Auerbach M. Patient education: Anemia caused by low iron in adults (beyond the basics) In: UpTpDate. Wolters Kluwer; 2022.
- National Heart, Lung, and Blood Institute. Iron-deficiency anemia
- Nagao T, Hirokawa M. Diagnosis and treatment of macrocytic anemias in adults. J Gen Fam Med. 2017;18(5):200-204. doi:10.1002/jgf2.31
- National Institutes of Health Office of Dietary Supplements. Vitamin B12
- MedlinePlus. Folate-deficiency anemia
- National Heart, Lung, and Blood Institute. Vitamin B12–deficiency anemia
- National Heart, Lung, and Blood Institute. Anemia treatment and management
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An MCH level above normal levels may indicate that you have macrocytic anemia due to low folate or B12 levels. Folic acid, or vitamin B9, helps in the production of red blood cells. Vitamin B12 is necessary for the development of healthy red blood cell formation.
Folate-deficiency anemia can develop if you:
- Don't take in enough folate in your diet (found in liver and green, leafy vegetables)
- Drink heavily in the long term
- Use certain medications, including Azulfidine (sulfasalazine) and Dyrenium (triamterene)
Vitamin B12–deficiency anemia can develop if your body can’t properly absorb vitamin B12.
This poor absorption can happen because of:
- A lack of intrinsic factor (a protein that helps your body absorb vitamin B12)
- Heavy alcohol use
- Certain medicines, such as heartburn medicine and the diabetes medication metformin
- Certain conditions, such as celiac disease, inflammatory bowel disease, and vitiligo
- Stomach surgery
While rare, you can also develop vitamin B12–deficiency anemia if your diet does not include enough vitamin B12.
MCH levels may also be high if you have anemia caused by chemotherapy.
Falsely high MCH levels may also appear in the setting of high cholesterol.
Symptoms of High MCH:
If you have high MCH due to anemia, you might experience symptoms of the anemia.
For both folate- and vitamin B12 deficiency anemia, that can include fatigue, weakness, headache, and paleness.
With folate deficiency anemia, you may experience sore mouth and tongue.
Because vitamin B12 is needed for proper brain and nerve function, you may experience problems with the following if you have vitamin B12–deficiency anemia:
- Walking
- Movement
- Thinking
- Smell
- Taste
- Vision
People with high MCH levels may also experience symptoms including:
- Unexplained fatigue
- Heart palpitations/complications
- Pallor
- Blood clots
- Blurred or double vision
- Dizziness
- Headaches
- Itching
Since this can interfere with heart function, early diagnosis of macrocytic anemia is important. Other possible reasons for a high MCH test include several other forms of anemia, thyroid dysfunction, chemotherapy, certain infections, over use of estrogen-containing medications, some forms of leukemia and hereditary spherocytosis; a condition that causes a shortage of red blood cells.
Having an MCH level above 31 picograms/cell can also be associated with the following conditions:
- Certain types of kidney diseases, including kidney cancer
- Congenital heart defect
- Lung disease, including chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis
- Polycythemia vera, a rare blood disease typically caused by a genetic mutation where the bone marrow produces too many red blood cells
Treatment for anemias caused by B-12 or folate deficiencies are commonly treated by lifestyle changes, such as adding foods rich in vitamin B-12 and folate to your diet. Your doctor may also recommend taking supplements of these vitamins to further boost your B-12 and folate levels or, if absorption is a problem, prescribe B-12 injections.
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A MCH level below 27 pg is most commonly associated with blood loss, iron deficiency and microcytic anemia, which is a condition in which red blood cells are abnormally small, carrying less hemoglobin.
Other possible causes:
- An autoimmune disease
- Cancer
- Deficiency of certain nutrients, such as vitamin B12 or folic acid
- Internal or external blood loss, often resulting from surgery, injury, or menstrual bleeding
- Iron deficiency, almost always caused by blood loss
- Kidney disease
- Liver disease
- Thalassemia, a common, inherited blood disorder caused by genetic mutations in the hemoglobin genes
- Hemoglobinopathy, which is a group of disorders that cause changes in the structure of hemoglobin, and iron-deficiency anemia.
Symptoms of Low MCH:
If you have a low level of MCH and are determined to have iron deficiency anemia, you might not have any symptoms. If you have been experiencing symptoms, they might include:
- Tiredness
- Shortness of breath
- Chest pain
- Fatigue
- Dizziness or lightheadedness
- Cold hands and feet
- Pale skin
- Weakness
What to do with your results?
Treatment for low MCH caused by iron deficiency can include adding iron-rich foods to your diet (there are even vegetarian options) and taking iron supplements. In rare cases, such as when symptoms are severe or blood loss has occurred, you may need a blood transfusion.
People with mild thalassemia may not require treatment. However, blood transfusions may be required if your symptoms are severe.
If you have had a CBC done; and, results show MCH levels that are higher or lower than normal, further investigation is warranted. While abnormal results are not necessarily an indication of serious health issues, as noted in the above lists; they can be significant, so it is important to rule them out. Many of the possible causes of abnormal MCH levels require treatment to protect health and well-being, such as anemia or other blood disorders, thyroid disease and nutritional deficiencies.
Your doctor may be able to determine the cause of abnormal MCH results with the help of other components of the CBC, such as MCV results, which measure the average size of red blood cells, or MCHC, which measures hemoglobin concentration.
Blood tests to determine your nutritional status may also be done to determine whether nutritional deficiencies are an issue. If your doctor suspects thyroid disease to be the root cause of your abnormal MCH levels, a blood test called a thyroid function panel may be needed to evaluate the health and function of your thyroid gland.
Depending on an evaluation of your general health and any symptoms you may be experiencing, your doctor may order a variety of other tests to determine the cause of your high or low MCH results.
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Haemoglobin (g/L), Hematocrit (Female range), Hematocrit (HCT) / Packed Cell Volume (PCV), Hemoglobin, Hemoglobin (Female range), Mean Cell Volume, Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC), Mean Corpuscular Volume (MCV), Mean Platelet Volume (MPV), Platelet count / Platelets, Platelet Distribution Width (PDW), Platelet-large cell ratio (P-LCR), RBC (Female range), RDW-CV (Red Cell Distribution Width) in %, RDW-SD (Red Cell Distribution Width) in fL, Red Blood Cells (Erythrocytes / RBC), White blood cells (Leukocytes / WBC)
