Blood count and blood group · Blood

MCH

The average amount of hemoglobin per red blood cell; follows the MCV and helps interpret the cause of anemia.

At a glance

Measured in blood
In 11 test panels
No special preparation

Explanation

MCH: what is measured?

MCH (mean corpuscular hemoglobin) is the average amount of hemoglobin in one red blood cell. The value is not measured directly but calculated: the hemoglobin divided by the number of red blood cells. Small cells contain less hemoglobin, large cells more; as a result, the MCH almost always moves in step with the MCV and rarely gives different information.

What can it detect?

Anemia due to iron deficiency or thalassemia (low MCH, cells with too little hemoglobin)
Deficiency of vitamin B12 or folic acid (high MCH, large cells)

Result

What does the result mean?

MCH too high

A raised MCH means that the red blood cells contain more hemoglobin than normal on average, almost always because they are larger (high MCV). Causes are a deficiency of vitamin B12 or folic acid, regular alcohol use, liver disease, an underactive thyroid and medicines such as methotrexate or antiepileptic drugs. Many young red blood cells after blood loss also raise the MCH. On its own, the value adds nothing beyond the MCV; the GP looks at the hemoglobin, the MCV and the possible causes.

MCH too low

A low MCH means that the red blood cells contain too little hemoglobin (hypochromic). Together with a low MCV and a low ferritin, this fits anemia due to iron deficiency, the most common cause. With a normal ferritin, it may be carriership of thalassemia, an inherited hemoglobin disorder that usually causes no symptoms, or anemia due to chronic inflammation. A slightly low MCH with a normal hemoglobin can be an early sign of a falling iron store, but on its own has little meaning.

After an abnormal result

The GP assesses the MCH together with hemoglobin, MCV and ferritin, following the Dutch GP guideline (NHG) on anemia: with a low MCH, testing for iron deficiency or thalassemia; with a high MCH, measurement of vitamin B12 and folic acid and attention to alcohol and medicines.

Reliability

How reliable is the test?

The MCH is a calculated value from the hemoglobin and the number of red blood cells and is therefore as reliable as those two measurements. The MCH gives virtually the same information as the MCV; the cause of anemia is determined with the MCV and the ferritin. A normal MCH does not rule out iron deficiency or a vitamin deficiency.

What can affect the result?

The MCH follows the MCV; anything that disturbs the MCV (alcohol, medicines, combined deficiencies, long transport time of the blood) also disturbs the MCH.
With a combined deficiency of iron and vitamin B12, the MCH can appear normal.
Reference values and units (fmol or pg) differ between laboratories.

Who it is for

Who is the test useful for?

Useful for

Only useful as part of a complete blood count when anemia is (suspected to be) present. As a single test, the MCH has no value; it is a calculated value that confirms the meaning of the MCV.

How common is it?

In general practice, anemia is diagnosed in about 9 in 1000 people per year; in half of them iron deficiency is the cause (low MCH), and in about 2 in 1000 per year a deficiency of vitamin B12 or folic acid (high MCH). About 1 in 100 Dutch people is a carrier of a hemoglobin disorder with a low MCH without iron deficiency.

Dutch GP guideline (NHG) on anemia (M76)

Drawbacks and risks

A slightly abnormal MCH with a normal hemoglobin and MCV is often flagged as abnormal in result lists even though it has no meaning; this can cause unnecessary worry.

Get tested

MCH: test panels

MCH is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.

Blood draw
General Health Checkup
With this General Health Check-up, you gain detailed insight into your overall health and well-being.
€ 125,00
Blood draw
Blood Count
Blood Count; complete analysis of blood cells for detection of anemia and infections.
€ 19,00
Blood draw
Complete Blood Count (CBC)
Complete Blood Count Extended; standard blood count plus detailed white blood cell analysis.
€ 27,00
Blood draw
InsideTracker
InsideTracker Blood Analysis: analyze 48 biomarkers for complete health optimization and personalized recommendations.
€ 335,00
Blood draw
Endurance Sports
Complete blood count, iron status (ferritin, transferrin), kidney function, liver function, testosterone, and hs-CRP. For athletes and endurance sport participants.
€ 203,00
Blood draw
Comprehensive Fatigue Test
Vitamin D, B12, TSH, fT4, glucose, MCV, ferritin, ESR and complete blood count. For persistent fatigue with inflammation check.
€ 152,00
Blood draw
Extended Cholesterol Test
Comprehensive cholesterol test with vitamin D, B12, and blood count. Combines heart health with a fatigue check in one package.
€ 98,00
Blood draw
Supplemental: Testosterone Replacement Therapy (TRT)
Complete hormonal analysis with testosterone, DHEA-S, thyroid, blood count, liver function, kidney function, lipids, glucose, HbA1c, insulin, hs-CRP, vitamin D and ferritin.
€ 335,00
Blood draw
Whoop (Advanced Labs)
Comprehensive blood analysis with biomarkers that integrates directly with your WHOOP wearable for optimal performance and recovery.
€ 385,00

How reliable is the test?

MCH