MCH and MCHC – Understanding Your Blood Test Result

Section Editor: Christopher McCudden Ph.D., DABCC, FADLM, FCACB
September 15, 2026

MCH and MCHC are two measurements that describe how much hemoglobin your red blood cells contain. Hemoglobin is the protein that carries oxygen and gives blood its red color. Both results appear automatically on a complete blood count, often shortened to CBC, and neither is ordered alone.

MCH stands for mean corpuscular hemoglobin. MCHC stands for mean corpuscular hemoglobin concentration. The names are similar, and the difference between them is easy to miss. This article explains what each one measures and what high and low results can mean. It also explains why MCHC has one particular use that the other red cell measurements do not.

The reference range that applies to your result is the one printed on your laboratory report, not the typical ranges shown here. Reference ranges vary between laboratories based on the equipment used, the population tested, and individual factors such as age, sex, and pregnancy status. Always compare your result to the reference range printed on your own report, and discuss any abnormal result with your doctor.

What is the difference between MCH and MCHC?

The distinction is easier with a comparison. Think of each red blood cell as a container and hemoglobin as what fills it.

MCH — the average amount of hemoglobin in one red blood cell. This is how much is in the container, without any reference to how big the container is.
MCHC — the average concentration of hemoglobin, meaning how much hemoglobin there is relative to the size of the cell. This is how full the container is.

The difference matters because a large cell can hold plenty of hemoglobin and still not be full. In that situation,n MCH is high while MCHC is normal. A small cell that is poorly filled will have both a low MCH and a low MCHC.

Your report may show MCH in picograms (pg) and MCHC in grams per liter or grams per deciliter, each printed next to a reference range. A typical adult MCH is approximately 27 to 33 pg. A typical adult MCHC is approximately 320 to 360 g/L, which is the same as 32 to 36 g/dL. Exact ranges vary between laboratories.

How do these fit with MCV?

MCV, MCH, and MCHC are calculated from the same underlying measurements and tend to move together. MCV describes cell size, MCH describes hemoglobin content, and MCHC describes hemoglobin concentration.

In practice, MCH usually follows MCV closely. Small cells hold less hemoglobin, so a low MCV is generally accompanied by a low MCH. For that reason, doctors often rely mainly on MCV and treat MCH as supporting information rather than as a separate line of investigation.

MCHC behaves a little differently, because it accounts for cell size. That independence is what makes it useful in a specific situation described below.

How are MCH and MCHC measured?

Both are measured from a small blood sample, usually taken from a vein in your arm. No fasting is needed. Neither is measured directly. The laboratory analyzer calculates both from your hemoglobin, red blood cell count, and hematocrit, so they appear automatically with a complete blood count.

Because they are calculated rather than measured, anything that affects those underlying results also affects MCH and MCHC.

What do MCH and MCHC results mean?

Read both alongside your hemoglobin, MCV, and RDW.

A low MCH or MCHC — a result below the reference range means the cells contain less hemoglobin than expected. Doctors call this hypochromia, which means the cells look paler than usual under the microscope. The commonest cause is iron deficiency, since iron is needed to make hemoglobin. Thalassemia trait can produce the same pattern.
A high MCH — a result above the reference range usually reflects large red blood cells rather than a problem with hemoglobin itself. It generally accompanies a high MCV, and the causes are the same: low vitamin B12 or folate, regular alcohol use, an underactive thyroid, or some medicines.
A high MCHC is less common and is interpreted differently from the others. See the next section, because it often points to a technical explanation rather than a medical one.
Normal results — alongside a normal hemoglobin are reassuring and are not usually commented on.

Why is a high MCHC treated differently?

There is a ceiling to how much hemoglobin a red blood cell can hold. A cell cannot be more than full. So a genuinely high MCHC is unusual, and when one appears, there are only a few explanations.

The first is interference with the measurement. Fat in the blood sample, a very high white cell count, or red blood cells clumping together can all produce a falsely high MCHC. Laboratories are alert to this and often repeat the test or add a comment.

The second is hereditary spherocytosis, an uncommon inherited condition in which red blood cells are rounder and smaller than usual, so their hemoglobin is more concentrated. A persistently high MCHC is one of the few laboratory signals that points to it, which is why this measurement is still reported.

Because the technical explanation is far more common than the medical one, an isolated high MCHC in someone who feels well is usually checked rather than investigated.

What conditions and factors can affect MCH and MCHC?

Common reasons these results can be low.

Iron deficiency — the most frequent cause, because iron is required to make hemoglobin.
Thalassemia trait — an inherited difference in hemoglobin production, usually harmless in the trait form and present lifelong.
Long-standing inflammation — which can reduce how much iron is available to the marrow even when the body’s iron stores are adequate.

Common reasons MCH can be high

Low vitamin B12 or folate — which produce larger cells carrying more hemoglobin each.
Regular alcohol use — a common cause of larger red blood cells.
An underactive thyroid, or liver disease — both of which increase cell size.

Reasons MCHC can be high

A technical interference — high blood fats, a very high white cell count, or clumped cells, as described above.
Hereditary spherocytosis — an uncommon inherited condition affecting the shape of red blood cells.

What other tests are ordered with MCH and MCHC?

Hemoglobin and hematocrit — which show whether anemia is present.
MCV — the measurement of cell size that these two are interpreted against.
RDW — which shows how much cell size varies.
Ferritin and iron studies — when low results suggest iron deficiency.
Vitamin B12 and folate — when a high MCH accompanies a high MCV.
A blood smear — which shows directly whether cells look pale or unusually shaped.

What happens after these tests?

MCH and MCHC rarely drive decisions on their own. Your doctor reads them as part of the whole red cell picture, and your hemoglobin and MCV usually determine what happens next.

If your results suggest iron deficiency, the usual next step is iron studies including ferritin. If they suggest large cells, vitamin B12 and folate testing is common, along with a review of your medicines. An isolated high MCHC with everything else normal is often repeated to rule out a sample issue. Treatment always addresses the underlying cause rather than these numbers, and they return toward normal as the cause is corrected. That takes weeks to months, because red blood cells live for around four months.

Questions to ask your doctor

What were my MCH and MCHC, and what are the reference ranges at this laboratory?
What was my MCV, and do these results fit together?
Is my hemoglobin normal, and am I anemic?
Do these results suggest iron deficiency?
Could my MCHC result be a sample issue rather than a problem with me?
How do these compare with my previous results?
Do I need iron studies, or vitamin B12 and folate testing?
Do you want to repeat the test, and if so, when?