What Is MCH In Blood Test | sameerbedar07

What Is MCH In Blood Test

What is MCH?

MCH is acronym for “mean corpuscular hemoglobin.” An MCH value refers to the average quantity of hemoglobin present in a single red blood cell. Hemoglobin is the protein in your red blood cells that transports oxygen to the tissues of your body.

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.

MCV is a measurement of the average size of your red blood cells. MCH results tend to mirror MCV results. This is because bigger red blood cells generally contain more hemoglobin while smaller red blood cells tend to have less.

MCHC is a calculation of the amount of hemoglobin per unit volume in a single red blood cell. The difference between MCH and MCHC is that the MCHC measurement takes the volume or size of the red blood cell into account while MCH does not.

How MCH is determined


Your MCH level is determined with a complete blood count (CBC) panel. Your doctor will order a CBC panel to screen for a large range of conditions, including anemia and infection. The CBC tests red and white blood cells, as well as platelets. MCH is calculated using the red blood cell analysis.

MCH is calculated by dividing the amount of hemoglobin in a given volume of blood by the number of red blood cells present. Normal range The normal range for MCH is between 27.5 and 33.2 picograms (pg).

Causes and Symptoms of low MCH


A low MCH value typically indicates the presence of iron deficiency anemia. Iron is important for the production of hemoglobin. Your body absorbs a small amount of iron that you eat in order to produce hemoglobin. Some of the general causes of iron deficiency include eating a diet that is low in iron, major surgery or trauma, or blood loss.

In rare cases, low MCH can be caused by a genetic condition called thalassemia. In this condition, the production of hemoglobin is limited. This means there aren’t as many red blood cells circulating in your bloodstream.

If you have a low MCH value, you may experience the following symptoms:

shortness of breath

chest pain

fast heartbeat

fatigue or weakness

very pale or yellowish skin


Causes and symptoms of High MCH


An MCH value calculated above 33.2 pg is considered high MCH. This means that there is a larger amount of hemoglobin present per red blood cell.

Causes High MCH value can often be caused by anemia due to a deficiency of B vitamins, particularly B-12 and folate. Both of these vitamins are required by your body in order to make red blood cells.

These types of anemia can develop if your diet is low in B vitamins or if your body does not absorb B-12 or folate properly. It’s important to be aware of the symptoms of a B-12 deficiency.

Symptoms If you have a high MCH value, you may experience the following symptoms:

shortness of breath

chest pain fast 


fatigue or weakness very pale or yellowish skin headache 

If you have anemia that’s due to B-12 deficiency, you may also experience: tingling or “pins and needles” in your hands or feet nausea or vomiting bloating and gas mental symptoms, such as depression or confusion If you have anemia due to folate deficiency, you could experience the following additional symptoms:


decrease in appetite

irritability a smooth or sensitive tongue

Treatment for high or low MCH


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. 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.

Factors Affecting MCH

The result of the univariate analysis of this study has shown that age, duration of the marriage, education, occupation, family income, parity, and distance are significantly correlated with the choice of MCH services used. These findings are in consonance with previous reports

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. Additionally, women’s MCH may be lower than men’s because of blood loss during menstruation, which can lead to iron deficiency.

Conversely, 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.

Outlook for MCH


The outlook for people with abnormal MCH values depends on the condition that’s causing it.

Low MCH values are often caused by iron deficiency anemia. Typically, this condition can be treated with lifestyle changes including consuming foods rich in iron as well as taking iron supplements. In the rare case that your low MCH value is caused by thalassemia, you may require blood transfusions if your symptoms are severe.

High MCH values caused by a deficiency of the vitamins B-12 or folate can also often be treated with changes to your lifestyle that include dietary modifications and supplements, or injectable B-12.

If you’re concerned about your MCH results, be sure to talk to your doctor about them. Together, you can decide on the best way to move forward.

Experimental Justification for its components

Hematological Parameters in Individuals with Beta Thalassemia


β-%alassemia has a very wide clinical variation, depending on the severity of the patient’s condition. Individuals with β-thalassemia traits are usually asymptomatic; however, laboratory examination will show mild anemia with microcytic hypochromic erythrocytes morphology with wide variation depending on the genotype. %is study was conducted to determine the reference value of hematological parameters and hemoglobin (Hb) analysis based on the phenotype of β-thalassemia and β+ ) and determine the differences of hematological characteristics between the two phenotypes.

Methods. %is cross-sectional study was conducted by evaluating the hematological parameters and Hb analysis of the β-thalassemia trait in the family of thalassemia patient population. %e subjects were divided into β0 and β+ . %e subject with normal Hb analysis with or without iron deficiency was excluded. Results.

A total of 203 subjects with thalassemia traits were included from the families of thalassemia patients, consisting of 101 subjects with β0 -thalassemia, 82 subjects with β+ -thalassemia, and the mutation had not been found in 20 subjects. %ere was a relationship in the mean/median of hematological parameters, HbA2 and HbF, between β0 –thalassemia and β+ -thalassemia (P < 0.05). ROC for each hematological parameter, HbA2 and HbF, showed that the highest diagnostic value based on the area under the curve was mean corpuscular hemoglobin (MCH) (0.900) and mean corpuscular volume (MCV) (0.898). %e cutoff point of MCH for β0 -thalassemia trait was ≤20.5 pg (sensitivity 85%, specificity 90%) and MCV was ≤66.8 fL (sensitivity 87%, specificity 87%). Conclusion. MCH values can be used as a screening tool for predicting β0 -thalassemia in the relatives of thalassemia patients in the South Sumatra population.



Non insulin dependent diabetes mellitus ( Type 2 diabetes) is a metabolic disorder caused either by the insufficient production of insulin in islet cells of the pancreas or by resistance against secreted insulin in tissue, leading to an elevation in the glucose concentration in blood. Several hematological changes affecting the red blood cells (RBCs), white blood cells (WBCs), and the coagulation factors are shown to be directly associated with DM (Mbata Ca et al.,2015) .Other hematological abnormalities reported in the DM patients include RBCs, WBCs, and platelet dysfunction.

The mean corpuscular hemoglobin concentration (MCHC) was higher in diabetics. However, mean corpuscular volume (MCV) of diabetics was lower. The quantitative and qualitative analysis of red cell parameters as measured by the red blood cell count, Hematocrit, Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin Concentration (MCHC) gives the indication of red cell deformability and the hemorheological state. The red blood cell distribution width (RDW) is a measure-ment of the size variation among circulating red cells and is calculated as part of the routine complete blood count. The RDW, along with mean cell volume, is useful in the differential diagnosis of the causes of anemia

Diabetic profiles are tightly linked to hemoglobin concentration.It is widely recognized that diabetic people are more vulnerable to the effects of anemia( Thomas MC.,2003 )AlKhoury. found that in patients with diabetes, hemoglobin is 1 g/dL lower for each stage of chronic kidney disease (CKD) than in the non-diabetic people (Al-Khoury S., 2006) . Several prospective studies have shown that a high hematocrit (or hemoglobin) predicts type 2 diabetes

However, the reasons for this association have not been fully explored. Hematocrit has been positively correlated with hyperinsuline- mia and conditions associated with insulin resistance such as high blood pressure, elevated serum triglycerides, low HDL cholesterol, and central obesity and could therefore be associated with insulin resistance (Barbieri M., 2001) On the other hand, hematocrit is also a major determinant of blood viscosity (MacRury SM.,1990). By mediating the primary phase of hemostasis, blood platelets play a pivotal role in the blood clotting process.

Terminology associated with MCH



According to a diagnostic standard operation procedure at the erythrocyte laboratory, University Children’s Hospital, Zurich. Samples were centrifuged for 5 or 10 consecutive minutes; 1, 2, or 4 times in a row. Energic mixing is required to resuspend the pellet before analysis or the next centrifugation cycle. In these experiments, the samples were vortexed for 2 s after each centrifugation. Controls were kept at room temperature in Eppendorf tubes as used in the experiments and vortexed for 2 s before analysis. The number of tested samples is indicated in the figure caption in the Results section. Per design, comparison of the controls vs. single centrifugation elucidates damage induced by centrifugation only, while comparison against samples centrifuged two to four times, demonstrates the damage induced by repeated centrifuging.


Mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were first introduced by Wintrobe in 1929 to define the size (MCV) and hemoglobin content (MCH, MCHC) of red blood cells.

Techniques for calculating MCH

Red cell indices MCV, MCH and MCHC are calculated from hemoglobin, hematocrit, and red blood cell count as follows:

Most clinical laboratories now use automated machines to perform blood counts (commonly called CBC) that include red cell indices as part of the profile. Two types of automated machines are generally used. Instruments like the Coulter S model employ the principle of electric impedance; others, like the Hemalog System Analyzer, use optical methods in performing cell counts. Most of the automated machines give the following values: white cell count, red cell count, platelet count, hemoglobin, hematocrit, MCV, MCH, and MCHC.

Newer machines, capable of calculating RDW or red cell morphology index, mean platelet volume, absolute lymphocyte count, and differential white cell count ate now being used in many clinical laboratories. These instruments are also capable of producing histograms.While the automated cell counters are fast, convenient, and precise, certain conditions can interfere with machine calculations and result in spurious values. It is important that clinicians become familiar with the more common causes of spurious results with electronic counters.

Features of MCH Test

  • In red cell agglutination, doublet erythrocytes are counted as one, and larger clumps are not counted as red blood cells at all. This leads to a "decrease" in red cell count and a falsely elevated MCV. Determination of the hemoglobin value is not affected. Prewarming the sample eliminates these spurious values.
  • In hyperglycemia, red cells are transiently hypertonic in relation to the isotonic diluting fluid, resulting in swollen cells and an elevated MCV. This can be avoided if some time is allowed for equilibration after dilution.
  • Hemoglobin is quantified based on its absorption characteristics. Conditions such as hyperlipidemias, hyperbilirubinemia, a very high white blood cell count, and high serum protein can interfere with this measurement and result in falsely elevated hemoglobin values.
  • Presence of immunoglobulins or fibrinogen precipitated by low temperatures in the blood sample leads to interference with cell counts, resulting in spuriously increased white blood cell count and sometimes small elevations in hemoglobin, hematocrit, red blood cell count, and a slight decrease in MCV. Prewarming the sample to 37°C will correct the artificial values.
  • When the values of hemoglobin, red cell count, and MCV are affected, MCH and MCHC also become abnormal, since these indices are calculated and are not directly measured.
Sometimes a set of spurious values may be the first clue to an otherwise unsuspected clinical condition (e.g., the combination of low hematocrit, normal hemoglobin, and high MCV and MCHC is characteristic of cold agglutinins). The MCV, since it is an average value, can be normal in the presence of two different cell populations (e.g., dimorphic anemias, red cell fragmentation with reticulocyte response). It is, therefore, important to examine the peripheral smear in the evaluation of anemias. When available, RDW is a good indicator of the degree of anisocytosis. Similarly, the red cell histogram, which offers a graphic depiction of red cell size distribution, will reveal anisocytosis even when the MCV is normal.

What is a CBC test?

The complete blood count (CBC) with differential is one of the most common laboratory tests performed today. It gives information about the production of all blood cells and identifies the patient's oxygen-carrying capacity through the evaluation of red blood cell (RBC) indices, hemoglobin, and hematocrit. It also provides information about the immune system through the evaluation of the white blood cell (WBC) count with differential.

These tests are helpful in diagnosing anemia, certain cancers, infection, acute hemorrhagic states, allergies, and immunodeficiencies as well as monitoring for side effects of certain drugs that cause blood dyscrasias. Nurses in the perianesthesia arena are frequently challenged to obtain and evaluate all or parts of the CBC as a part of the patient's preoperative, intraoperative, and postoperative assessments. An enhanced understanding of this laboratory test is essential to providing quality care.

Determining Cell Count and Cellular Hemoglobin

We demonstrate a blood analysis routine by observing red blood cells through light and digital holographic microscopy in a microfluidic channel. With this setup, a determination of red blood cell (RBC) concentration, the mean corpuscular volume (MCV), and corpuscular hemoglobin concentration mean (CHCM) is feasible.

Cell count variations in between measurements differed by 2.47% with a deviation of − 0.26 × 10 6µ L to the reference value obtained from the Siemens ADVIA 2120i. Measured MCV values varied by 2.25% and CHCM values by 3.78% compared to the reference ADVIA measurement. Our results suggest that the combination of optical analysis with microfluidics handling provides a promising new approach to red blood cell counts.

Microscopic Techniques

Images of blood cells were acquired by combining two optical technologies, basic light microscopy and digital holographic microscopy (DHM) in a single microscopic configu- ration (Figure 1a). A custom-built microscope purchased from Ovizio Imaging Systems, Belgium, combines two light beams from two independent light sources.

 Light emitting diodes (LEDs, Dragon1 PowerStar Colors, Osram, Thatcham, UK) were selected to either emit blue light at 455 nm or green light at 530 nm. The light paths of the simultaneously triggered LEDs are combined via a dichroic mirror and travel through a microfluidic chan- nel. After the sample plane, a 40 × achromatic objective (numerical aperture (NA)=0.75, Nikon) magnifies the sample plane. Another dichroic mirror splits the light beam again into two separate paths. 

The blue path is captured directly by a monochromatic CCD-sensor (Grasshopper3 USB3, FLIR) (Figure 1a, camera 1), while the green light beam enters a patented [ , ] differential digital holographic module. In this module a diffraction grat- ing, placed at the input plane, generates different diffraction orders, where the zero-order diffraction is referred to as the reference wave, while the first order diffraction carries the phase information of the sample. 

The phase content of an investigated object depends on variations in the refractive index and physical height. Wedges can adjust path differences between the two waves, while filters can select the desired diffraction orders. Both wave fronts are recombined under a certain angle at the camera plane (Grasshopper3 USB3, FLIR) (Figure 1a, camera 2). This single-shot technique can acquire fast (100 fps, acquisition time 20 µs) and stable images with nanometer resolution

Frequently Asked Questions

What does it mean when your MCH level is low?

A low MCH value typically indicates the presence of iron deficiency anemia. Iron is important for the production of hemoglobin. Your body absorbs a small amount of iron that you eat in order to produce hemoglobin.

What does it mean if your MCH is high?

High MCH scores are commonly a sign of macrocytic anemia. This condition occurs when the blood cells are too big, which can be a result of not having enough vitamin B12 or folic acid in the body.

What does it mean when your MCV and MCH are high?

What Do High MCH Levels Mean? Your MCH will reflect your MCV. That means you'll have more hemoglobin if your red blood cells are larger than normal. Red blood cells can grow too large when you have fewer of them than normal -- a condition called macrocytic anemia.

MCH is reported as picograms per cell (pg). The American Board of Internal Medicine lists a typical MCH count reference range as 28-32 pg/cell. When MCH results fall outside of the reference range, it indicates that the amount of hemoglobin in your blood cells may be too low or too high.


High MCH, MCHC along with plateau effect beyond 110fl at RU end of RBC histogram are good indicators of the presence of cold antibodies in plasma. The above findings along with anemia and nucleated RBC are clues for the presence of pathologic cold antibodies whereas the absence of anemia with the above findings suggests the presence of benign cold antibodies in plasma. In all cases with plateau effect beyond 110fl at RU end of RBC histogram, cold antibodies in plasma must be also be considered in addition to other causes while reporting the peripheral smear.

References or cited sources

1. Bessman JD, Gilmer PR, Gardner FH. Improved classification of anemias by MCV and RDW. Am J Clin Pathol. 1983;80:322–26. [PubMed]

1. Cornbelt J. Spurious results from automated hematology cell counters. Lab Med. 1983;14:509–14. 2. Gottfried EL. Erythrocyte indexes with the electronic counter. N Engl J Med. 1979;300:1277. [PubMed]

3. Johnson CS, Tegos C, Beutler E. Thalassemia minor: routine erythrocyte measurements and differentiation from iron deficiency. Am J Clin Pathol. 1983;80:31–36. [PubMed]

4. McClure S, Custer E, Bessman JD. Improved detection of early iron deficiency anemia in non-anemic subjects. JAMA. 1985;253:1021–23. [PubMed] 5. Payne BA, Pierre RV, Morris MA. Use of instruments to obtain red blood cell profiles. J Med Tech. 1985;2:379–88. 6. Rose MS. Epitaph for the MCHC. Br J Med. 1971;4:169. [PMC free article] [PubMed]

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