If a person is not feeling well and visited the doctor’s office or hospital, one of the tests ordered is CBC or complete blood count. It checks various components of the blood so as to give the doctor a general overview of the patient’s health. The result of the test is used as a basis for diagnosing and treating the patient’s condition.

One of the blood components measured in the routine blood check is MCH. It stands for Mean Corpuscular Hemoglobin. It measures the amount of hemoglobin present in red blood cells. It is checked to diagnosed blood and iron-related disorders. What is hemoglobin? It is a protein that stores oxygen. It enables your blood to transport oxygen throughout the body.

The mean corpuscular hemoglobin is one of the three red blood cell indices. The other two are MCV and MCHC. A special machine is used to determine the level of MCH in the blood. (1, 2, 3, 4, and 5)

image shows the level of MCH; a proportion of hemoglobin to red blood cells

Image 1: The image shows the level of MCH; a proportion of hemoglobin to red blood cells.
Picture Source: healthtestingcenters.com

How to calculate the level of MCH?

The level of MCH is calculated by multiplying the number of hemoglobin in a particular volume of blood by ten and divide by the number of red blood cells. (4)

The formula used to calculate MCH level

Image 2: The formula used to calculate MCH level.
Picture Source: slidesharecdn.com


What is the Normal MCH level?

The normal MCH reading is between 27 and 31 pg per cell. The reading is low if it falls below 25 and high if it is 35 or higher. (5)

What does a low MCH mean?

If the MCH level is low, it means that the red blood cells are smaller than normal. The condition is called microcytosis. What’s even alarming is that symptoms do not show up until the condition gets severe.

If the MCH reading is lower than the usual, other blood parameters have to be checked to come up with an accurate diagnosis. Such tests include iron markers, MCV, and RDW. (4, 5, and 6)

A patient with an extremely low MCH level may experience the following:

  • Easy fatigability
  • Loss of stamina
  • Shortness of breathe
  • Dizziness
  • Tiredness even with just minimal effort
  • Weakness
  • The skin becomes pale or yellowish
  • The patient gets bruised easily (5, 6, and 7)
Anemia is one of the leading causes of low MCH reading

Image 3:Anemia is one of the leading causes of low MCH reading.
Picture Source: 

Thalassemia is also linked with the decrease in MCH reading

Image 4: Thalassemia is also linked with the decrease in MCH reading.
Picture Source: 

What are the possible reasons behind low MCH reading?

  1. Iron deficiency anemia – It is one of the reasons for having a low MCH. In a study made, about 82% of patients who have a low MCH have iron deficiency anemia and most of them have Celiac disease too. This condition leads to the poor absorption of iron leading to iron deficiency anemia.
  2. Thalassemia – It is a blood-related disorder characterized by abnormal hemoglobin in the blood causing the MCH level to go down. (6, 7, and 8)


What can you do to normalize the level of MCH?

  1. Watch your diet – Make sure you eat a healthy and balanced diet. Increase your intake of iron-rich foods to prevent the possibility of having iron deficiency anemia. Rich sources of iron are:
    1. Eggs
    2. Meat
    3. Liver
    4. Nuts
    5. Edible seeds
    6. Tofu
    7. Whole grains
    8. Dried fruits (3, 5)

Foods to avoid

These foods decrease the absorption of iron into the body:

  • Tea
  • Coffee

2. Take iron supplements – If you are a vegetarian and you can’t include meat products in your diet, the best thing to do is to take iron supplements.

3. Blood transfusion – If the symptoms are severe such as severe blood loss, your doctor will order a blood transfusion to compensate for the blood loss. (6, 8, 9, and 10)

What does a high MCH mean?

If your MCH level is high, it means that your red blood cell is bigger than the usual. The condition is called macrocytic, which is associated with an underlying medical condition.

A high MCH level can go unnoticed for a long period of time until such time that the condition gets wore and symptoms began to appear. These include the following:

  • Paleness of the skin
  • Easily gets tired
  • Rapid beating of the heart
  • Confusion
  • Inability to concentrate
  • Nails get brittle and break easily
  • Memory loss
  • Digestive-related issues such as diarrhea
  • Loss of appetite leading to drastic weight loss
  • Nausea with or without vomiting
  • Smooth/sensitive tongue (3, 5, and 9)
MCH is dramatically high in patients with megaloblastic anemia

Image 5: MCH is dramatically high in patients with megaloblastic anemia.
Picture Source: 

What causes a high MCH level?

  1. Megaloblastic Anemia – It is caused by a deficiency in vitamin B 12 or folate.
  2. Vices – Those who have a lot of vices such as chronic smoking and heavy alcohol consumption have higher chances of having a high MCH level than those who lead a healthy lifestyle.
  3. Malaria infection – Infections caused by Falciparum malaria have a high MCH level. (1, 4, and 9)

How to bring down  the MCH level?

  • Diet – What you eat plays a vital role in normalizing the level of MCH. To bring down a high MCH level, you should increase your intake of foods rich in folate and vitamin B12 such as:
    • Green leafy vegetables
    • Meat products, especially chicken, beef, lamb, and turkey
    • Dairy products like milk and yogurt
    • Pork liver
  • Live healthy – Improve your way of life.
    • Reduce your intake of alcoholic beverages.
    • Cut or totally stop smoking.
    • Consider taking supplements such as vitamin B12 and folate. (4, 5, 9, and 10)


To determine the outlook of the patient with MCH abnormalities, the underlying condition has to be established. If it is caused by iron deficiency anemia, the outlook is good as it can be easily corrected through diet, supplement, and lifestyle modification.

If the underlying cause is thalassemia, you might need to undergo a regular blood transfusion, especially if the condition is severe. It is important to consult your primary care physician to determine the underlying cause and come up with a better solution. That way, your outlook or prognosis can be improved significantly. (4, 6, and 9)

Frequently Asked Questions

Q 1. What does MCH mean in a blood test when it is high?

A high MCH reading is commonly associated with macrocytic anemia which is caused by insufficient vitamin B12/folic acid. It could also be linked to liver-related diseases and overactive thyroid gland.

Q 2. What does it mean when your MCH level is low?

If the value of MCH is low, it means that you could be suffering from iron deficiency anemia.

Q 3. What does it mean when your MCV and MCH are low?

When both MCV and MCH levels are low, it indicates hypochromic microcytic anemia such as iron deficiency, thalassemia, and anemia secondary to inflammatory diseases. It could also indicate congenital defects in metabolism of copper, genetic determinants for HbC, and sideroblastic anemia.

Q 4. What are the symptoms of low MCHC?

The cardinal signs and symptoms of low MCHC are shortness of breath, fatigue, pale skin, chronic tiredness, dizziness, easy bruising, weakness, and loss of stamina.

Q 5. What is the difference between MCH and MCHC?

MCH pertains to the amount of hemoglobin that is present in red blood cells. The normal MCH value is are 29 ± 2 picograms (pg) per cell. On the other hand, MCHC pertains to the amount of hemoglobin per unit volume.

Q 6. What is MCV in blood test high?

An MCV reading that is more than 100 fL is considered high. It is usually found in patients suffering from macrocytic anemia.

Q 7. What is MCHC in blood test normal range?

The normal range of MCHC in a blood test for adults is between 33.4 to 35.5 grams per deciliter.

Q 8. What should I do if my hemoglobin is low?

If your hemoglobin level is low, there are many things you can do to bring it back to a normal level such as:
Consuming diet high in iron.
Increase your intake of vitamin C including diet and supplement.
Increase your intake of folic acid, both diet, and supplement
Exercise regularly
Avoid things or foods that have iron-blocking property
Include apple, pomegranate, or nettle tea in your diet.

Q 9. Can dehydration cause high RBC?

If you are dehydrated, there is not enough water in the body, which causes the red blood cells to be more concentrated. The more concentrated the red blood cell is, the higher it is in number.

Q 10. Is low MCHC bad?

A low MCHC is usually associated with anemia. However, if you are in the intensive care unit and your blood work shows a low MCHC, it is a red flag as it shows poor outcomes. For normal people with low MCHC, it signals a developing iron-deficiency anemia.

Q 11. What foods are high in iron?

Iron can be obtained from your diet. If you have a low iron level, then you have to increase your intake of the following foods:
1. Tofu
2. Cashew nuts
3. Baked potatoes
4. Beans and lentils
5. Whole grain enriched bread
6. Dark green and leafy vegetables such as spinach

Q 12. How long does it take for MCV to return to normal?

If you have taken all the necessary measures to normalize the level of MCV, you would usually wait for at least two months before you can see positive outcomes.

Q 13. What is the most common cause of microcytic anemia?

Microcytic anemia is commonly a result of iron deficiency in the blood secondary to inadequate intake of iron-rich foods.

Q 14. What is the MCV normal range?

The normal MCV reading ranges between 80 and 100 fL.

Q 15. What causes changes in MCV?

A change in MCV level such as high MCV is linked to macrocytic anemia secondary liver-related disease, vitamin B12 deficiency anemia, and folate deficiency anemia.

Q 16. What causes Microcytosis without anemia?

The usual causes of microcytosis are anemia such as iron deficiency anemia and thalassemia. However, if anemia is not present and microcytosis is noted, then it could be linked to lead toxicity and chronic disease.

Q 17. Which nut is highest in iron?

Nuts are known to be a great source of iron, but not all nuts have the same iron contents. If you are looking for nuts with the highest iron content, then the number one on the list is pistachios followed by almonds, brazils, and cashews.

Q 18. Are Bananas high in iron?

Yes, bananas are rich in iron. On top of that, it is also rich in folic acid and vitamin B12, which are all helpful in addressing anemia.

Q 19. What fruit is high in iron?

Fruits can be a great source of iron such as apricots, prunes, peaches, currants, raisins, pears, figs, and apples.

Q 20. How can I lower my red blood cells naturally?

Having a high red blood cell count is not beneficial for the body. Fortunately, you can lower red blood cells naturally through the following ways: Limit the intake of iron-rich foods and red meat. Make it a habit to exercise regularly to improve the functions of the heart and lungs. Keep the body well-hydrated. Stay away from coffee and other caffeinated beverages. Quit smoking, especially if you have pulmonary fibrosis and chronic obstructive pulmonary disease.

Q 21. Why are my red blood cells high?

Your red blood cell count is abnormally high if it is more than 6.1 million for men, more than 5.4 million for women, and more than 5.5 million for children. Your doctor will conduct a thorough investigation to determine what is causing high red blood cells. It is usually associated with diseases/disorders such as congenital heart disease, heart failure secondary to low blood oxygen level, tumor in the kidneys, lung-related diseases like COPD, emphysema, and pulmonary fibrosis. It could also be due to polycythemia vera, hypoxia, and exposure to carbon monoxide. An abnormally high red blood cell could be related to lifestyle too such as chronic cigarette smoking, intake of performance-enhancing drugs like anabolic steroids, and living at a high altitude.

Q 22. What do basophils indicate?

Basophils are a type of white blood cells found in the bone marrow. What they do is they keep the immune system functioning properly. In routine blood work, basophils are indicators of certain health problems. If the level of basophil is abnormally low, it could indicate an allergic reaction. Although it could be linked to other conditions.


  1. https://www.medicalnewstoday.com/articles/318192.php
  2. https://www.healthline.com/health/mch
  3. https://selfhacked.com/blog/mch-blood-test-high-low-levels-normal-range/
  4. https://emedicine.medscape.com/article/2054497-overview
  5. https://www.verywellhealth.com/mean-corpuscular-hemoglobin-concentration-797200
  6. https://www.brighthub.com/science/medical/articles/71162.aspx
  7. https://www.livestrong.com/article/552363-what-is-the-nutritional-significance-of-a-low-mch-and-a-low-mchc/
  8. https://en.wikipedia.org/wiki/Mean_corpuscular_hemoglobin
  9. https://www.wikihow.com/Increase-MCH-Levels
  10. https://healthjade.com/mch-blood-test/#What_is_MCH

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