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The Mean Corpuscular Hemoglobin Concentration (MCHC) is one of the key red blood cell indices reported on a complete blood count (CBC) test. It measures the average concentration of hemoglobin inside a single red blood cell.
Hemoglobin is the iron-containing protein in red blood cells that carries oxygen to tissues throughout the body. The MCHC blood test provides important information about the hemoglobin content and size of red blood cells, which can help diagnose various blood disorders and medical conditions.
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What Is the MCHC Blood Test?
The MCHC is calculated by dividing the hemoglobin concentration by the hematocrit (the percentage of red blood cells in the blood). The normal MCHC range for adults is 32-36 grams per deciliter (g/dL). Values below 32 g/dL indicate hypochromia (pale red blood cells with decreased hemoglobin), while values above 36 g/dL suggest hyperchromia (red blood cells with increased hemoglobin concentration).
The MCHC is often interpreted along with other red blood cell parameters like:
- Mean corpuscular volume (MCV): Average size of red blood cells
- Mean corpuscular hemoglobin (MCH): Average amount of hemoglobin inside a single red blood cell
- Red cell distribution width (RDW): Variation in size of red blood cells
Together, these indices provide a complete picture of red blood cell health and can point to specific types of anemia or other blood disorders.
Causes of High MCHC Levels.
An MCHC above the normal range is called hyperchromia. Some potential causes of a high MCHC include:
- Spherocytosis: An inherited disorder that causes red blood cells to be small, dense, and sphere-shaped rather than the normal biconcave disc shape. These abnormal cells are fragile and break down faster.
- Autoimmune hemolytic anemia: The immune system mistakenly attacks and destroys red blood cells faster than they can be replaced. This leads to a shortage of red blood cells.
- Hemoglobin C disease: A genetic hemoglobin variant that causes red blood cells to be abnormally dense and fragile, increasing MCHC.
In some cases, an MCHC result that is slightly above the normal range may be a lab error rather than an indicator of a medical condition. Dehydration and certain medications can also increase MCHC levels1.
Causes of Low MCHC Levels
An MCHC below the normal range is called hypochromia. It means the red blood cells have a lower than normal concentration of hemoglobin.
Potential causes include:
- Iron deficiency anemia: Not enough iron to produce adequate amounts of hemoglobin. This is the most common cause of a low MCHC.
- Thalassemia: Inherited blood disorders that cause the body to produce less hemoglobin than normal and abnormally shaped red blood cells.
- Sideroblastic anemia: A rare blood disorder where the bone marrow produces ringed sideroblasts rather than healthy red blood cells. It can be caused by a genetic mutation or acquired later in life.
- Lead poisoning: Lead can interfere with several steps in hemoglobin synthesis, leading to a decreased MCHC.
Hypochromia often occurs along with microcytosis (smaller than normal red blood cells), resulting in a low MCV in addition to the low MCHC.
Interpreting MCHC Blood Test Results
The MCHC is just one piece of the puzzle when it comes to diagnosing blood disorders. Doctors will consider the MCHC result in the context of the other red blood cell indices, a person’s symptoms, medical history, and physical exam findings. Additional tests may be ordered to confirm a suspected diagnosis.
Some examples of how MCHC results are interpreted:
- Normal MCHC with a normal MCV and MCH: This generally indicates healthy red blood cells and hemoglobin levels. Anemia is unlikely.
- Low MCHC with a low MCV: This pattern is characteristic of iron deficiency anemia and thalassemia. Iron studies can differentiate between the two.
- Low MCHC with a normal MCV: Possible early iron deficiency before red blood cells become microcytic. Sideroblastic anemia and lead poisoning are other considerations.
- High MCHC with a normal MCV: May indicate spherocytosis, especially if there are signs of hemolysis like an elevated reticulocyte count, low haptoglobin, and high lactate dehydrogenase.
- High MCHC with a high MCV: Suggests hemoglobin C disease or another hemoglobinopathy. Hemoglobin electrophoresis can provide a definitive diagnosis.
It’s important to remember that a single abnormal MCHC result does not necessarily mean a person has a blood disorder. The test may need to be repeated to see if the result is consistent. Even if the MCHC remains abnormal, it is just a sign that points to a possible underlying condition. Further evaluation is needed to make a diagnosis.
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Symptoms Related to Abnormal MCHC Levels
In many cases, people with an abnormal MCHC do not have any noticeable symptoms. The condition is often discovered incidentally on routine blood work. When symptoms do occur, they are typically related to the underlying cause of the abnormal MCHC rather than the MCHC itself.
Some signs and symptoms that may occur along with a low MCHC due to iron deficiency anemia include:
- Fatigue
- Weakness
- Pale skin
- Shortness of breath
- Chest pain
- Headaches
- Cold hands and feet
With hemolytic anemia due to spherocytosis or autoimmune destruction of red blood cells, symptoms may include:
- Jaundice (yellowing of the skin and eyes)
- Dark urine
- Enlarged spleen
- Gallstones
Lead poisoning can cause a variety of symptoms depending on the level of exposure:
- Abdominal pain
- Constipation
- Irritability
- Difficulty concentrating
- Seizures
Thalassemia and hemoglobin C disease may be asymptomatic or cause mild anemia symptoms like fatigue. Sideroblastic anemia can cause:
- Fatigue
- Shortness of breath
- Pale skin
- Enlarged liver and spleen
Anytime anemia symptoms occur, it’s important to see a doctor to determine the underlying cause and appropriate treatment1.
Conditions Diagnosed by the MCHC Blood Test
The MCHC blood test alone cannot diagnose any condition, but it can provide valuable clues about what might be going on.
Some conditions where the MCHC may be abnormal include:
- Iron deficiency anemia: The most common cause of a low MCHC. It occurs when there is not enough iron to produce adequate hemoglobin.
- Thalassemias: Inherited blood disorders characterized by decreased hemoglobin production and abnormally shaped red blood cells. The MCHC is often low.
- Spherocytosis: An inherited condition where red blood cells are small, dense, and sphere-shaped, causing an elevated MCHC. The abnormal cells are fragile and break down faster than normal.
- Autoimmune hemolytic anemia: Occurs when the immune system mistakenly attacks and destroys red blood cells. The MCHC may be high due to the increased density of the remaining red cells.
- Sideroblastic anemia: A rare blood disorder characterized by ringed sideroblasts in the bone marrow and a low MCHC. Can be inherited or acquired.
- Hemoglobin C disease: A genetic hemoglobin variant that causes red blood cells to be abnormally dense, resulting in an increased MCHC.
- Lead poisoning: Lead interferes with hemoglobin synthesis and can cause a low MCHC along with microcytic anemia.
In addition to the MCHC, other tests are needed to diagnose these conditions. For example, iron studies are used to diagnose iron deficiency anemia, while hemoglobin electrophoresis can identify hemoglobin variants like hemoglobin C disease. A bone marrow biopsy may be needed to diagnose sideroblastic anemia. Genetic testing can provide a definitive diagnosis of thalassemia and other inherited blood disorders1.
The Bottom Line
The MCHC is an important red blood cell index that reflects the average concentration of hemoglobin in a single red blood cell. It is one of several parameters reported on a complete blood count (CBC) that doctors use to evaluate red blood cell health and diagnose blood disorders.A low MCHC indicates the red blood cells have less hemoglobin than normal, which can be a sign of iron deficiency anemia, thalassemia, sideroblastic anemia, or lead poisoning.
A high MCHC suggests the red blood cells are denser than normal, which may occur with spherocytosis, autoimmune hemolytic anemia, or hemoglobin C disease.However, an abnormal MCHC alone is not diagnostic of any condition. It is just one piece of information that doctors consider along with a person’s symptoms, medical history, physical exam, and other test results.
Additional testing is often needed to determine the underlying cause of an abnormal MCHC and guide treatment decisions.If you have questions or concerns about your MCHC results, talk to your doctor. They can help you understand what your results mean in the context of your overall health and recommend any necessary follow-up testing or treatment.
Disclaimer: This article is for general informational purposes only and does not constitute professional medical advice. The information is provided “as is” without any representations or warranties, express or implied. Always consult a qualified healthcare provider for personalized medical guidance. The author and publisher disclaim any liability for actions taken or not taken based on this article’s content. Use of this information is at your own risk. If you suspect a medical problem, contact your doctor immediately. By reading this article, you agree to these terms. Your health is your responsibility.
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