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High & Low Mean Corpuscular Hemoglobin Concentration (MCHC)

Written by Biljana Novkovic, PhD | Last updated:
Puya Yazdi
Medically reviewed by
Puya Yazdi, MD | Written by Biljana Novkovic, PhD | Last updated:

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MCHC can help diagnose different blood disorders, such as anemia. Keep reading to find out what causes high and low MCHC, and how to address them.

What is MCHC?

MCHC is normally a part of a complete blood count, which measures your red blood cells, white blood cells, and platelets.

Mean corpuscular hemoglobin concentration (MCHC) is the average amount of hemoglobin per red blood cell, relative to the size of the cell. In other words, it tells you what percentage of your blood cells are made up of hemoglobin, the protein that helps transport oxygen in the blood [1, 2].

Decreased MCHC causes hypochromia (“hypo-” = low, “chromia” = color), which makes the red blood cells paler. Meanwhile, increased MCHC causes red blood cells to become darker, also known as hyperchromia [2, 3].

In short, MCHC is an indirect measure of how much hemoglobin you have. The added value of this test over direct hemoglobin is that it adjusts for the rate of the production of red blood cells [4+].

In many cases, when hemoglobin production is reduced, the production of red blood cells is likewise reduced. However, in some cases, hemoglobin production can be reduced, while red blood cell production can increase. This can help differentiate specific conditions from one another [4+].

Gut bleeding is an example where both hemoglobin and red blood cells may be reduced in a similar fashion, due to blood loss [4+].

However, in iron deficiency, hemoglobin can go down, while red blood cells can be less affected. In these cases, MCHC would be lower than when there is blood loss [4+].

Normal MCHC

MCHC normally ranges from 320 – 360 g/l [5].

There can be some lab-to-lab variability in ranges due to differences in equipment, techniques, and chemicals used.

Low MCHC

A low mean corpuscular hemoglobin concentration (MCHC) can cause hypochromia, or paler red blood cells. Hypochromia is a sign of anemia [2].

However, a result that is slightly lower may not be of medical significance, as this test often varies from day to day and from person to person. Your doctor will interpret this result, taking into account your medical history and other tests, such as RBC, hemoglobin, and other red blood cell indices.

Causes of Low MCHC

Causes shown below are commonly associated with low MCHC. Work with your doctor or other health care professional to get an accurate diagnosis of the underlying cause.

1) Iron Deficiency

One of the most common causes of low MCHC is iron deficiency and iron deficiency anemia [6, 5]. Iron is necessary to produce hemoglobin, so if you are deficient in iron, you will produce less hemoglobin for each given red blood cell.

Iron deficiency can be due to a dietary deficiency, gut issues that decrease iron absorption (e.g. Celiac disease), or toxins that interfere with iron absorption (e.g. lead) [6, 5, 7].

2) Anemia of Chronic Disease

Many different types of infection can reduce MCHC, such as:

Infections cause inflammation, which in turn causes people to produce less hemoglobin. Presumably, in these infections hemoglobin is being reduced more than red blood cells, so MCHC is lower.

3) Thalassemia

Thalassemia is a blood disorder that causes abnormal hemoglobin production. People with alpha- and beta-thalassemia have lower MCHC than healthy people [11, 12, 13].

4) Sideroblastic Anemia

A rare genetic disorder called inherited sideroblastic anemia can decrease MCHC [14].

Increasing MCHC

Work with your doctor to find out what’s causing your low MCHC and to treat any underlying conditions. Attempting to raise MCHC artificially may not address underlying health conditions and ultimately may do more harm than good. If you have a low MCHC, your doctor may order additional tests and/or use this result to help make a diagnosis and determine an appropriate course of action, which may or may not include the strategies below.

Discuss the strategies listed below with your doctor. None of them should ever be done in place of what your doctor recommends or prescribes!

Make sure your diet is well balanced and contains enough nutrients, especially iron. This will prevent nutritional deficiencies that can cause problems with red blood cells [6, 5]. However, remember that nutrient deficiencies can also have non-dietary causes, such as bleeding or gut issues (malabsorption), in which case they can’t be corrected by simple dietary adjustments.

Avoid drinking tea and coffee with meals. These decreasing the absorption of iron into the body [15, 16].

Discuss the following supplements with your doctor:

  • Iron (if deficient) [6, 5]
  • Vitamin C (if deficient in iron) – it increases the absorption of iron [17]

High MCHC

A high mean corpuscular hemoglobin concentration (MCHC) can cause hyperchromia, or darker colored red blood cells [3].

However, a result that is slightly higher may not be of medical significance, as this test often varies from day to day and from person to person. Your doctor will interpret this result, taking into account your medical history and other tests, such as RBC, hemoglobin, and other red blood cell indices.

Causes of High MCHC

Causes shown below are commonly associated with high MCHC. Work with your doctor or other health care professional to get an accurate diagnosis of the underlying cause.

1) Hemolytic Anemia

Hemolysis is the rupture or destruction of red blood cells. It is one of the most common causes of increased MCHC [18, 19]. This is because red blood cells are decreasing, while hemoglobin is relatively unchanged.

This type of anemia can occur due to various causes, including autoimmune anemia (e.g. cold agglutinin disease) [18, 1, 20].

2) Vitamin B12 and Folate Deficiency

Vitamin B12 and folate deficiency can increase MCHC [21, 22]. That’s because they can impair the production of red blood cells without affecting hemoglobin.

3) Hereditary Spherocytosis

Hereditary spherocytosis is a genetic condition in which red blood cells get destroyed and MCHC increases. People who have this disorder have significantly higher MCHC than healthy people [3].

Decreasing MCHC

Work with your doctor to find out what’s causing your high MCHC and to treat any underlying conditions! Attempting to decrease MCHC artificially may not address underlying health conditions and ultimately may do more harm than good. If you have a high MCHC, your doctor may order additional tests and/or use this result to help make a diagnosis and determine an appropriate course of action, which may or may not include the strategies below.

Remember to discuss the strategies listed below with your doctor. None of them should ever be done in place of what your doctor recommends or prescribes!

Make sure you eat a healthy diet that contains enough nutrients, especially vitamin B12 and folate. This will prevent nutritional deficiencies that can cause problems with red blood cells [22]. However, keep in mind that nutrient deficiencies can also have non-dietary causes, such as gut issues (malabsorption), in which case they can’t be corrected by simple dietary adjustments.

Alcohol consumption can reduce B12 and folate levels [23, 24, 25]. Avoid alcohol if your MCHC is high due to vitamin B12 deficiency.

Smoking (nicotine) can also lower B12 and folate levels [26, 27], and is best reduced or avoided altogether.

If you are deficient in either B12 or folate, your doctor will likely prescribe supplements.

About the Author

Biljana Novkovic

Biljana Novkovic

PhD
Biljana received her PhD from Hokkaido University.
Before joining SelfHacked, she was a research scientist with extensive field and laboratory experience. She spent 4 years reviewing the scientific literature on supplements, lab tests and other areas of health sciences. She is passionate about releasing the most accurate science and health information available on topics, and she's meticulous when writing and reviewing articles to make sure the science is sound. She believes that SelfHacked has the best science that is also layperson-friendly on the web.

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