Red cell indices and how it can save your life

The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.

Red cell indices measure the morphology or physical appearance of our red blood cells. Red cell indices, together with the red cell count, are components of a Complete Blood Count (CBC), a commonly requested test used for a variety of purposes. They are most useful when someone presents with anaemia (below normal level of haemoglobin)

A typical red cell index calculates 4 components of the red cells, including 1. Mean Corpuscular Haemoglobin (MCH), 2. Mean Corpuscular Haemoglobin Concentration, 3. Red Cell Distribution Width (RDW), and 4. Mean Corpuscular Volume (MCV). All 4 components of the red cell index are evaluated together to help determine the appropriate diagnosis for a red blood cell abnormality.

Mean Corpuscular Haemoglobin (MCH)

Mean corpuscular haemoglobin (MCH) is the average amount of haemoglobin in your red blood cells. Haemoglobin is a protein in your blood which traps and transports oxygen to the cells and tissues of your body.

Normal MCH values in adults are in the range of 27 to 33 picograms (pg) per cell. The values are different in children. Should your MCH level be abnormal, visit a medical professional to get examined and further managed to find a cause and treat accordingly.

Abnormal MCH Values

If you experience high or low MCH levels, it may indicate the presence of different types of anaemia. High MCH often occur when the amount of haemoglobin in each red cell is higher than normal. This is a common symptom of a type of anaemia called macrocytic anaemia. When this happens, red blood cells appear bigger than normal. Causes of high MCH are vitamin B12 and folic acid deficiency, liver diseases, excess alcohol consumption, overactive thyroid gland, and certain types of cancer.

On the other hand, low MCH levels indicate that the haemoglobin in your red blood cells is lower than normal. This is usually caused by an iron deficiency, which will then affect our red blood cells. This happens because iron is vital in the body’s production of haemoglobin.

Should you suffer from abnormal MCH levels, there are several tests that you should go for to ensure your body stays in tip-top condition. These tests would help to check your complete blood count, reticulocyte count and the levels of potassium and ferritin in your blood.

Signs and Symptoms of abnormal MCH levels

If you suffer from abnormally low or high MCH levels, you may not show any symptoms at all. However, if left untreated or undiscovered for some time, you will begin to experience symptoms of anaemia including shortness of breath, fatigue, weakness, dizziness/lightheadedness, irregular heart beat or headaches.

Treatment of abnormal MCH levels

If you feel any of these symptoms, it is best that you see a doctor as soon as you can. However, for low MCH, one good way of balancing your MCH value is to incorporate iron-rich foods into your diet. These food sources of iron include liver, meat, fish, eggs, pulses, nuts and seeds, dried fruit, and whole grains.

If you have high MCH levels, you will need to have more food sources of vitamin B12 and folic acid incorporated into your diet. These include leafy green vegetables, citrus fruits, broccoli, lemons, bananas, mushrooms, beans, rice, cereals, and pasta.

If dietary changes do not improve your symptoms, you may require vitamin or iron supplements. In severe cases, you might even require a blood transfusion.

Mean Corpuscular Haemoglobin Concentration (MCHC)

While the MCH refers to the mass of haemoglobin in red blood cells, the mean corpuscular haemoglobin concentration (MCHC) refers to the concentration of haemoglobin in your red blood cells. It measures the average weight of haemoglobin per unit volume of your blood. Normal MCHC values range from 32 to 36 grams per deciliter.

Abnormal MCHC levels

Your MCHC values may be above or below the normal limits, even if you have an adequate amount of red blood cells. Factors which reduce the concentration of haemoglobin in your red blood cells (low MCHC) include a lack of iron, thalassaemia, chronic blood loss, and the poor ability to absorb iron, such as Crohn’s disease, celiac disease, and gastric bypass surgery. In rare cases, low MCHC may result from lead poisoning, hookworm infections, and cancers which cause blood loss.

A high MCHC value can be caused by diseases including spherocytosis where the red blood cells are larger than normal, thus housing a higher number of haemoglobin molecules than normal. Other causes of high MCHC include vitamin B12 and folic acid deficiencies, thyroid dysfunction, and the use of cancer drugs.

To evaluate the cause of abnormal MCHC levels, your doctor may recommend other tests such as an endoscopy to view your gut, blood tests to check your thyroid function, a haemoglobin electrophoresis test of the blood for thalassaemia, and/or Vitamin B12 and folic acid levels.

Abnormal MCHC values may cause the heart to work harder, in order to pump more blood to meet your body’s demands for oxygen. In time, this may wear your heart out and cause possible heart failure.

Signs and Symptoms of abnormal MCHC levels

High and low MCHC levels lead to symptoms of insufficient supply of oxygen to your cells and tissues. These symptoms include a fast heart rate, shortness of breath, sweating, confusion, and rapid breathing.

Treatment of Abnormal MCHC levels

The most common cause of a low MCHC is iron deficiency. Thus, it is extremely beneficial to add iron-rich foods to your diet. Additionally, foods rich in fibre and vitamin B-6 can also help aid in your gut’s absorption your gut health and aid it in absorb iron. Foods rich in vitamin B-6 include bananas, chicken breast, spinach, and wild tuna will balance MCHC abnormalities caused by vitamin B12 and folate deficiencies.

In some cases, your doctor may recommend folic acid and vitamin B-12 supplements for daily consumption.

Red Cell Distribution Width (RDW)

RDW is a measure of variation in the volume or width of your red blood cells. The reference range for RDW is 39 to 46 fluid ounce (fl) and is usually interpreted in relation to the mean corpuscular volume (MCV) to make interpretations and diagnoses.

Abnormal RDW results

Elevated RDW indicates that your red blood cells vary a lot in volume or size, and it is often found in a number of diseases. RDW values are always evaluated along with your MCV values to formulate a diagnosis. Common causes of elevated RDW include folate and vitamin B12 deficiency, and chronic liver disease.

Low RDW levels indicate that your red blood cells have little variation in size. Additionally, people who lack key vitamins and nutrients, such as B12 and iron, may also face low RDW concentrations. However, it is noted that in some cases, this same lack of vitamins could also result in high RDW concentrations. Thus, when you experience abnormal RDW concentrations, it is always safer to visit a doctor and do further testing.


Mean Corpuscular Volume (MCV)

MCV refers to the average size of your red blood cells in a specimen of blood. The reference range for MCV is 80 to 96 fluid ounce/ red cell. An MCV test is usually part of a CBC test. Additionally, it can be used either to monitor or diagnose certain blood disorders.

Abnormal MCV results

If you suffer from low MCV results, it means your red blood cells are smaller than usual. This could be due to a variety of reasons. Examples of such reasons are iron deficiency anaemia and genetic diseases affecting the structure of your red blood cells such as thalassaemia and sideroblastic anaemia.

However, if you have high MCV levels, it means that your red blood cells are larger than normal. It occurs in conditions such as folate deficiency, vitamin B12, excess alcohol intake, aplastic anaemia, and liver disease.

However, normal MCV values may also occur when the body suffers from certain diseases such as acute blood loss, diseases which cause excess breakdown of red blood cells such as spherocytosis and haemolytic anaemia, and anaemia resulting from chronic diseases.

Abnormal MCV levels result in anaemia which presents symptoms such as fatigue, fast heart rate, and shortness of breath.

Treatment of abnormal MCV levels

You can prevent and treat MCV abnormalities by incorporating iron, folate, and vitamin B12 rich foods in your diet. In cases caused by genetic diseases, you may need to avoid certain exacerbating factors such as drugs, stress, and dehydration. Anaemia caused by chronic diseases, however, are treated by a doctor and also includes management of the chronic disease. In some of these cases, you may require blood transfusion.

Red cell indices are an extremely vital part of blood tests as they analyse red blood cells in detail. Thus, they have the ability to help diagnose the type of anaemia. It is important to undergo a complete blood test annually to ensure that your body stays healthy and any potential health risks are detected early.

So put your fear of needles aside and book a blood test today. After all, our health should always be our number one priority.

If you want to find out more about anaemia and how you can balance your red blood cell count, take a look at our lifestyle article here!

Interested in other biomarkers, check out the rest of The Biomarker Handbook.

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