• Red Blood Cell Indices
• Red cell mass measurement
• Erythrocyte indices
• Mean corpuscular hemoglobin
• Mean corpuscular hemoglobin concentration

• Lavender top tube or EDTA microtainer
• 5 mL of whole blood or fill microtainer

This section details the MCH and MCHC are routine parts of the Complete Blood Count (CBC) test.

Mean Corpuscular Hemoglobin (MCH)

• Average weight of Hgb in each RBC
• Of value in the differential diagnosis in the anemic patient

Mean Corpuscular Hemoglobin Concentration (MCHC)

• Average concentration of Hgb in the RBC
• Most valuable item to utilize in monitoring therapy for anemia

I. MCH- Mean Corpuscular Hemoglobin

The MCH is the mean amount of hgb in a single RBC, which is from the hgb and the RBC count, using the following formula:

MCH(pg/cell) = Hgb (g/dL) × 10/RBC (10¹²/L)

• An elevated level is associated with macrocytic anemia and is common in newborns.
• A decreased level is associated with microcytic anemia.

II. MCHC – Mean Corpuscular Hemoglobin Concentration

• The MCHC is the average concentration of Hgb in the RBC and is the most sensitive test to monitor the success of therapy for anemia
• The MCHC is calculated using the formula: MCHC = MCH (g/dL) × 100/Hct (%)

These tests are indicated for:

• Evaluation of Anemia
• Detection of a hematologic disorder, neoplasm or immunologic abnormality
• Determination of the presence of hereditary hematologic abnormalities
• Monitoring the effects of acute or chronic blood loss
• Monitoring hematologic status during pregnancy
• Monitoring patients with disorders associated with elevated or decreased erythrocyte counts
• Monitoring the progression of non-hematologic disorders associated with abnormal erythrocyte counts
• Adrenal dysfunction
• Bone marrow failure
• Cancers
• COPD
• Hypothyroidism
• Liver disease
• Malabsorption syndromes
• Renal disease
• Monitoring response to drugs or chemotherapy and to evaluate undesired reactions to drugs that may cause blood dyscrasias

Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.

I. Conditions with elevation of MCH include:

• Cold agglutinins
• High heparin concentrations
• Hyperlipidemia
• Macrocytic anemias (See section on MCV)
• Oral contraceptives (long-term use)
• Rouleaux formation
• Spherocytosis
• WBC >50,000/mm³ falsely raises the Hgb value and therefore elevates the MCH

II. Conditions with elevation of MCHC include:

• Cold agglutinins
• Dehydration (Severe & prolonged)
• High heparin concentrations
• Lipemia
• Macrocytic anemias (See section on MCV)
• Newborns and infants
• Oral contraceptives (long-term use)
• Rouleaux formation
• Spherocytosis

^*Note: RBCs cannot accommodate more than 37 g/dL (370 g/L) of Hgb

I. Conditions with decreased MCH & hypochromia include:

• Hypochromic anemias
• Microcytic anemias (See section on MCV)

II. Conditions with decreased MCHC include:

• Drugs – Styrene
• Hemolytic anemia
• Microcytic anemias (See section on MCV)

• Chen B H et al. Effect of different anticoagulant, underfilling of blood sample and storage stability on selected hemogram. Kaohsiung J Med Sci 1999 Feb;15(2):87-93
• Demir A et al. Most reliable indices in differentiation between thalassemia trait and iron deficiency anemia. Pediatr Int. 2002 Dec;44(6):612-6
• Gwendolyn M et al. Laboratory Investigation of Hemoglobinopathies and Thalassemias: Review and Update. Clinical Chemistry. 2000;46:1284-1290
• LabTestsOnline®. CEA. [Homepage on the Internet] © 2001-2006. Last reviewed on March 23, 2006. Last accessed on September 8, 2006. Available at URL:
  http://www.labtestsonline.org/understanding/analytes/cbc/glance.html
• Melo M R et al. The use of erythrocyte (RBC) indices in the differential diagnosis of microcytic anemias: is it an approach to be adopted? Rev Assoc Med Bras 2002 Jul-Sep;48(3):222-4.
• Tsang C W et al. Hematological indices in an older population sample: derivation of healthy reference values. : Clin Chem. 1998 Jan;44(1):96-101