Understanding MCHC Blood Test Results

Know, however, that your MCHC value may be normal with many types of anemia (normochromic anemias), such as:

MCHC Blood Test Results: Meaning of Low and High Levels

Douglas A. Nelson, MD, is double board-certified in medical oncology and hematology. He was a physician in the US Air Force and now practices at MD Anderson Cancer Center, where he is an associate professor.

Table of Contents
Table of Contents

Mean corpuscular hemoglobin concentration (MCHC) describes the average hemoglobin concentration in a given volume of red blood cells. It’s a lab value that’s found on a complete blood count (CBC). An MCHC blood test may be used as a preliminary check for anemia.

A normal MCHC value on a CBC is typically between 32 to 36 grams per deciliter (g/dL) or 320 to 360 grams per liter (g/L). A higher or lower than normal MCHC value may indicate that you have a type of anemia, which means you have a low red blood cell count, but your healthcare provider may order more diagnostic tests to be sure.

Learn about MCHC, including its importance and what may cause a high or low MCHC value.

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Purpose of MCHC Blood Test

MCHC is a measure of the concentration of hemoglobin in red blood cells. Since hemoglobin is the molecule to which oxygen attaches, MCHC is a measure of the average oxygen-carrying capacity of the red blood cells circulating in the body.

The MCHC is done as part of a CBC, so the test is done any time a CBC is ordered. For example, this may include routine health screenings or during the diagnosis, treatment, and follow-up of a wide range of medical conditions.

A healthcare provider may specifically look at MCHC results:

• When symptoms of anemia are present, such as fatigue, pale skin, or light-headedness
• When looking for the different causes of anemia (when a person’s red blood cell count and/or hemoglobin levels are low)

While the MCHC value is helpful in diagnosing anemia, it is also used along with the red blood cell count and other red blood cell indices such as mean corpuscular volume (MCV) and red cell distribution width (RDW) to help diagnose other health issues.

Hemoglobin is what gives red blood cells their color. A higher concentration of hemoglobin with high MCHC makes the cells appear darker (hyperchromic), while a low concentration with low MCHC makes them appear lighter (hypochromic).

How MCHC Is Calculated

MCHC is calculated by multiplying the hemoglobin level times 10 and then dividing by the hematocrit level, which is the volume percentage of red blood cells in your blood. The number is recorded in grams per liter.

• MCHC = Hb x 10 / hematocrit

MCHC may also be calculated by dividing the mean corpuscular hemoglobin (MCH) (i.e., the average mass of hemoglobin in each red blood cell) by the MCV, the average size of the red blood cells:

• MCHC = MCH / MCV

MCHC Results and What They Mean

A low MCHC (hypochromia) may mean that there is a lower concentration of hemoglobin within a given volume of red blood cells, and, hence, a reduced capacity to carry oxygen to the body’s tissues.

A high MCHC (hyperchromia) can mean that there is a higher hemoglobin concentration in red blood cells than usual.

Know, however, that your MCHC value may be normal with many types of anemia (normochromic anemias), such as:

• Blood loss anemia
• Anemia due to kidney disease
• Mixed anemias
• Bone marrow failure
• Hemolytic anemias (many types)

What’s a Normal MCHC Result?

The reference or “normal” range for MCHC can vary somewhat between different labs, but it is usually between 32 g/dL to 36 g/dL (or 320 g/L to 360 g/L). Some labs have a smaller range of normal, for example, between 33.4 g/dL and 35.5 g/dL.

Causes of a Low MCHC

Possible causes of low MCHC include:

• Iron deficiency (with or without anemia)
• Lead poisoning
• Thalassemias (beta thalassemia, alpha thalassemia, and thalassemia intermedia)
• Sideroblastic anemia
• Anemia of chronic disease

A low MCHC without anemia is associated with poor outcomes for people in intensive care. It may also indicate iron deficiency before anemia develops.

Causes of a High MCHC

There can be various reasons for a high MCHC. For instance, MCHC may be falsely increased due to cold agglutinin disease (CAD), a rare autoimmune disorder in which the body’s immune system attacks red blood cells.

Potential causes of a high MCHC with anemia include:

• Autoimmune hemolytic anemia (due to medications, autoimmune conditions, and more)
• Hereditary spherocytosis
• Severe burns
• Liver disease
• Hyperthyroidism
• Sickle cell disease (homozygous)
• Hemoglobin C disease

Inaccurate MCHC Results

The MCHC is calculated from hemoglobin and hematocrit, so anything that interferes with these numbers will make the MCHC inaccurate.

For example, your MCHC reading after a blood transfusion may be inaccurate. This is because blood drawn after a blood transfusion will be a mixture of donated cells plus a person’s normal red blood cells.

Other limitations that can affect the accuracy of your MCHC reading include:

Combined Anemia

If a person has two different types of anemia that lead to different MCHC levels, the reading won’t be as helpful in diagnosing the type of anemia. For example, the MCHC may be normal if a person has a combination of iron-deficiency anemia (which causes a low MCHC) and spherocytosis, a condition that causes red blood cells to be sphere-shaped (which tends to cause a high MCHC).

Conditions Making Hemoglobin or Hematocrit Inaccurate

Health conditions that affect hemoglobin or hematocrit levels can give a false MCHC result.

For example, hyperlipidemia (an increased level of cholesterol or triglycerides), hyperbilirubinemia (elevated bilirubin levels in the blood, as with liver disease), and autoagglutination (the clumping of red blood cells) will cause the hematocrit level to be falsely high, and the hemoglobin levels to be falsely low.

With hemolysis (breakdown of red blood cells), free hemoglobin in the plasma leftover from the broken red blood cells will also cause an abnormal result—meaning the MCHC will be falsely increased.

MCHC Blood Test Procedure

You likely have gotten your MCHC checked without even realizing it, since it’s part of routine blood work.

Here’s a walk-through of how a sample of blood is drawn for testing.

Before the Test

There are no dietary or activity restrictions before having a CBC. It is important to bring your insurance card to your appointment and ensure your healthcare provider has access to prior CBCs you have had for comparison.

During the Test

The test can be conducted in many hospitals and clinics. Prior to drawing your blood, a lab technician will cleanse the area (usually a vein in the arm) with an antiseptic, and a tourniquet is applied to visualize the vein better. If you have a chemotherapy port, blood can be drawn directly from the port.

The technician will then insert the needle into a vein. You may feel a sharp poke when the needle enters and some pressure as it remains in place. Some people may feel lightheaded or faint with the needle stick. Make sure to let the technician know if you are feeling lightheaded.

After obtaining the sample, the technician will remove the needle and ask you to hold pressure over the site. When the bleeding has stopped, a bandage or gauze will be applied to your arm to keep the area clean and to reduce the chance of further bleeding.

After the Test

When the test is done, you will be able to return home and resume your regular activities. Potential side effects include:

• Pain from the needle stick, especially if a number of attempts are made
• Difficulty obtaining a specimen from a blood draw (such as in people whose veins are difficult to access due to chemotherapy)
• Bleeding (bleeding can take longer to stop in people who are on blood thinners or have a bleeding disorder)
• Hematoma or a large bruise (can be uncomfortable, but it is very uncommon)
• Infection (when the needle is inserted, there is a small risk of bacteria being introduced into the body)

If your clinic has a lab on site, you may receive your results shortly after the test is drawn. Other times, your healthcare provider may call you to give you your results.

It is important to be your own advocate and ask for the actual numbers (for example, your MCHC) rather than whether your CBC is simply in a normal range.

Complementary Tests

In addition to MCHC, a CBC provides a good amount of information about the body’s cells, including the total number of red blood cells, white blood cells, and platelets, as well as the previously mentioned red blood cell indices:

• Mean corpuscular volume (MCV): The measure of the average size of the red blood cells
• Red cell distribution width (RDW): The number that reflects the variation in sizes of the red blood cells
• Mean corpuscular hemoglobin (MCH): The average mass of hemoglobin per red blood cell

Other tests may be done to further clarify information found on the CBC and help diagnose a specific type of anemia. These tests include:

• Peripheral blood smear for morphology: A peripheral smear involves looking at the blood sample under the microscope. This allows the lab professional to directly visualize other changes in the red blood cells that may be associated with anemia, such as target cells, nucleated red blood cells, and more.
• Iron studies: Serum iron and iron-binding capacity and/or ferritin levels can give valuable information on iron stores and can help discriminate iron deficiency from other anemias with a low MCHC.
• Vitamin B12 level: Vitamin B12 levels are helpful in looking for pernicious anemia.
• Bone marrow aspiration and/or biopsy: In some cases, a bone marrow study may be needed to assess the appearance of blood cells in the bone marrow and iron stores.

Summary

Mean corpuscular hemoglobin concentration (MCHC) is a measure of the concentration of hemoglobin in red blood cells. It is a value seen on a complete blood count (CBC), which includes information about the total number of red blood cells, white blood cells, platelets, and other red blood cell indices.

A normal MCHC value is typically in the range between 32 g/dL to 36 g/dL (320 g/L to 360 g/L). A higher or lower than normal MCHC may indicate a type of anemia.

A Word From Verywell

The MCHC test is most meaningful when combined with other results on a CBC and can be helpful in discovering causes of anemia as well as predicting prognosis in those without anemia.

When using these results, however, it is very important to be aware of the limitations as well as the potential for error. It is best to consider any findings only after they are repeated and supported by other tests.

Frequently Asked Questions

What happens if MCHC count is low?

A low mean corpuscular hemoglobin concentration (MCHC) count is when there is less hemoglobin, the protein that carries oxygen, in red blood cells. Low MCHC indicates that red blood cells are less capable of delivering oxygen to the body’s tissues.

What level of MCHC is dangerously low?

While a dangerously low MCHC value may vary from one person to another depending on health conditions, a MCHC level lower than 30 g/dL, especially in the lower 20s, may warrant concern.

What happens when the MCHC level is high?

A high MCHC can mean that you have a higher than normal concentration of hemoglobin in your red blood cells. Health conditions like hereditary spherocytosis and autoimmune hemolytic anemia may cause a high MCHC.

What is hypochromia?

Hypochromia is when red blood cells appear more pale than usual when examined under a microscope. This is a side effect of having a low MCHC, since hemoglobin carries the pigment that gives red blood cells their color.

10 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. MedlinePlus. RBC indices.
2. MDApp. Mean corpuscular hemoglobin concentration (MCHC) calculator.
3. Labpedia. Anemias types and characteristic finding (classification of anemias).
4. Huang YL, Hu ZD. Lower mean corpuscular hemoglobin concentration is associated with poorer outcomes in intensive care unit admitted patients with acute myocardial infarction. Ann Transl Med. 2016;4(10):190. doi:10.21037/atm.2016.03.42
5. Onishi S, Ichiba T, Miyoshi N, Nagata T, Naito H. Unusual underlying disorder for pulmonary embolism: Cold agglutinin disease. Journal of Cardiology Cases. 2017;15(2):43-45. doi: 10.1016/j.jccase.2016.10.005
6. Cancer Therapy Advisor. Hereditary spherocytosis.
7. Dorgalaleh A, Mahmoodi M, Varmaghani B, et al. Effect of thyroid dysfunctions on blood cell count and red blood cell indice. Iran J Ped Hematol Oncol. 2013;3(2):73-7.
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9. Medical Laboratory Online. Identifying and managing hemolysis interference with CBC specimens.
10. MedlinePlus. Hypochromia.

Additional Reading

• Huang YL, Hu ZD. Lower mean corpuscular hemoglobin concentration is associated with poorer outcomes in intensive care unit admitted patients with acute myocardial infarction. Ann Transl Med. 2016;4(10):190. doi:10.21037/atm.2016.03.42
• Lee JM, Nadimpalli SB, Yoon JH, Mun SY, Suh I, Kim HC. Association between mean corpuscular hemoglobin concentration and future depressive symptoms in women. Tohoku J Exp Med. 2017;241(3):209-217. doi:10.1620/tjem.241.209
• McPherson R., Pincus M., eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. St Louis, MO: Elsevier
• Qu X, Zhang T, Ma H, Sui P, Du J. Lower mean corpuscular hemoglobin concentration is associated with unfavorable prognosis of resected lung cancer. Future Oncol. 2014;10(14):2149-2159. doi:10.2217/fon.14.121

By Lynne Eldridge, MD
Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of “Avoiding Cancer One Day at a Time.”

Understanding MCHC Blood Test Results

The blood test can be helpful in diagnosing anemia.

Updated on January 23, 2023
Medically reviewed by

Steffini Stalos, DO, FCAP, is a pathology and lab medicine physician. She is also the chief medical officer of the lab consultancy firm Blood Associates, LLC.

Mean corpuscular hemoglobin concentration (MCHC) is a measurement of the amount of hemoglobin a red blood cell has relative to the cell’s volume. Hemoglobin is a protein in red blood cells that carries oxygen throughout the body.

Measuring hemoglobin through an MCHC blood test can help determine whether you have a medical condition, for MCHC levels that are too low or high can signal several conditions. In fact, MCHC is a standard measurement in the diagnosis of anemia, a condition marked by low levels of red blood cells and that can cause tiredness or weakness.

Understanding Your Results

MCHC is one of the measurements taken during a complete blood count (CBC). A CBC is a common blood test. Your healthcare provider might order one for you to help diagnose or monitor certain conditions. You might also hear a CBC be referred to as a full blood count.

Once your CBC test results are ready, you and your provider will be able to see your MCHC.

The normal range for MCHC is 32 to 36 grams per deciliter (g/dL) or 320 to 360 grams per liter (g/L). Since different laboratories might use different measurements or blood samples, you should talk with your healthcare provider about what a normal range is for you.

An MCHC that is below or above the normal range can develop for a number of reasons.

Causes of Low MCHC

MCHC measurements that are below the normal range can be a sign of iron-deficiency anemia. Iron-deficiency anemia develops when you don’t have enough iron in your body. You need iron to make red blood cells. A lack of iron can impact the production of healthy red blood cells and, thus, your MCHC levels.

Iron-deficiency anemia is the most common type of anemia. It can develop when there is:

• Trouble absorbing iron: This can be the effect of endurance sports, digestive conditions, and certain genetic conditions.
• Kidney disease: With this, your kidneys don’t make enough erythropoietin, a substance needed to make red blood cells.
• Chronic inflammation: Conditions that cause long-lasting inflammation can make it hard for your body to use iron.

Low MCHC can also be due to thalassemia. Thalassemia is an inherited blood disorder in which the body does not make enough hemoglobin.

Causes of High MCHC

Depending on the kind you have, anemia may cause high MCHC. Hemolytic anemia may lead to an MCHC measurement above the normal range. Hemolytic anemia develops when red blood cells break down faster than they can be replaced. This type of anemia can happen for a number of reasons, including:

• Autoimmune conditions
• Infections
• Sickle cell disease
• Blood transfusion complications

Higher-than-normal MCHC results may also be attributable to hereditary spherocytosis, a rare genetic condition in which the body makes abnormally shaped red blood cells.

Editor’s Note: Even if your MCHC is within a normal range, it is still possible to have a certain type of anemia. With normocytic normochromic anemia, the circulating red blood cells are the same size (normocytic) and have a normal red color (normochromic). This type of anemia can develop for multiple reasons, including acute blood loss and kidney disease.

What to Expect When Taking an MCHC Blood Test

A healthcare provider will perform an MCHC blood test by drawing blood as part of a CBC. No preparation is needed prior to a CBC. However, if your healthcare provider has ordered other tests in addition to a CBC, you may need to fast for several hours before that test. Your provider will let you know if there are any special instructions to follow.

Using a small needle, a healthcare provider will take a blood sample from a vein in your arm. The small amount of blood that the needle takes is collected into a vial. As the needle goes in or out, you may feel a slight sting. The entire process usually takes less than five minutes.

After the test, you may experience bruising or mild pain where the needle was inserted. You might also feel dizzy for a brief period of time.

Related Blood Tests

MCHC is just one measurement of red blood cells included in a CBC. A CBC includes other tests to measure the size, shape, and quality of your red blood cells. As a collective, these measurements are called red blood cell indices. The indices can help diagnose anemia.

Besides MCHC, other red blood cell indices are:

• Mean corpuscular volume (MCV): Measures of the average size of your red blood cells
• Mean corpuscular hemoglobin (MCH): Measures the average amount of hemoglobin per red blood cell
• Red cell distribution width (RDW): Measures differences in the volume and size of your red blood cells

Next Steps

If your MCHC is above or below the normal range, your healthcare provider will likely talk with you about potential causes and, if needed, treatment plans to address the cause. Any treatment plan would depend on what condition is behind the abnormal MCHC readings.

Anemia is usually what’s associated with abnormal MCHC levels. If a healthcare provider determines that anemia is the cause of your low or high MCHC levels, they will want to figure out what is causing the anemia and treat that cause. Treatments for anemia and the conditions that cause it may include:

• Medication
• Dietary supplements
• Blood transfusion
• Blood or bone marrow transplant

Editor’s Note: Low levels of MCHC have been shown to be associated with poorer outcomes among people hospitalized with acute heart attack or acute pulmonary embolism. Research has found that people with either of these conditions who also had low MCHC were more likely to die within 30 days to a year from the event. Low MCHC levels may be a predictor in outcome of certain cases of heart attack or pulmonary embolism.

A Quick Review

The MCHC is a measurement of the amount of hemoglobin a red blood cell has relative to the size of the cell. MCHC below or above the normal limit may be a sign of anemia, meaning you do not have enough healthy red blood cells. MCHC is a test that is part of a CBC. Your healthcare provider may order a CBC as part of a routine exam or if you have symptoms of anemia, a family history of a blood disorder, or a diet low in iron. The test is quick and requires no preparation. Depending on your results, your healthcare provider might talk to you about the potential cause of a high or low reading. And depending on any symptoms you may have and your past medical history, they will likely talk to you about treatment options to address your anemia.

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