MCV, MCH, MCHC
Measures of red blood cell size and hemoglobin content
20 of 22 providers
Complete Blood Count (CBC)
MCV:80-100 fL, MCH:27-33 pg, MCHC:32-36 g/dL
What is MCV, MCH, MCHC?
MCV (Mean Corpuscular Volume), MCH (Mean Corpuscular Hemoglobin), and MCHC (Mean Corpuscular Hemoglobin Concentration) are red blood cell indices that describe the size and hemoglobin content of your RBCs. MCV measures average RBC volume (80-100 femtoliters or fL), MCH measures average hemoglobin per RBC (27-33 picograms), and MCHC measures hemoglobin concentration within RBCs (32-36 g/dL).
These indices are critical for classifying anemia types:Microcytic (low MCV <80 fL) suggests iron deficiency or thalassemia. Macrocytic (high MCV >100 fL) suggests B12/folate deficiency or alcohol use. Normocytic (normal MCV) suggests anemia of chronic disease or blood loss. MCH generally mirrors MCV, while MCHC is most useful for detecting hereditary spherocytosis (elevated MCHC) or iron deficiency (low MCHC).
MCV is the most clinically useful index, guiding targeted testing:low MCV → check iron studies and hemoglobin electrophoresis (thalassemia). High MCV → check B12, folate, thyroid function, liver function. Normal MCV with anemia → check reticulocyte count, kidney function, inflammatory markers. The Mentzer index (MCV/RBC) helps distinguish iron deficiency (>13) from thalassemia trait (<13) when MCV is low.
Why RBC Indices Classify Anemia and Guide Treatment
- Anemia classification:MCV categorizes anemia into microcytic (small cells), macrocytic (large cells), or normocytic (normal size)—each with different causes and treatments
- Iron deficiency detection:Low MCV + low MCH + low MCHC is classic triad of iron deficiency, the most common anemia worldwide
- Thalassemia screening:Low MCV with normal/high RBC count suggests thalassemia trait. Mentzer index <13 distinguishes from iron deficiency
- B12/folate deficiency:High MCV >110 fL strongly suggests megaloblastic anemia requiring B12/folate testing
- Alcohol use marker:MCV 100-110 fL without anemia common in chronic alcohol use, even with adequate B12/folate
- Early detection:MCV changes occur before anemia develops, allowing earlier intervention
Optimal vs Standard Ranges
OptimalMCV:85-95 fL, MCH:28-32 pg, MCHC:33-35 g/dL▼
- Ideal RBC size and hemoglobin content
- Indicates adequate iron, B12, and folate stores with efficient hemoglobin packaging
- These values support optimal oxygen delivery and cellular function
BorderlineMCV:78-85 or 95-102 fL▼
- Low-normal MCV suggests early iron deficiency or thalassemia trait
- High-normal may indicate early B12/folate deficiency, hypothyroidism, or alcohol use
- Check ferritin, B12, folate, thyroid function
- Retest in 3 months
Microcytic (Small RBCs)MCV <80 fL▼
- Small RBCs indicate iron deficiency (most common), thalassemia, anemia of chronic disease, lead poisoning, or sideroblastic anemia
- Check iron studies (ferritin, TIBC, iron saturation)
- If iron normal, consider hemoglobin electrophoresis for thalassemia
- Mentzer index (MCV/RBC):>13 suggests iron deficiency, <13 suggests thalassemia
Macrocytic (Large RBCs)MCV >100 fL▼
- Large RBCs indicate B12 deficiency, folate deficiency, hypothyroidism, liver disease, alcohol use, or medications (methotrexate, hydroxyurea, antiretrovirals)
- MCV >110 suggests megaloblastic anemia (B12/folate deficiency)
- Check B12, folate, TSH, liver enzymes, alcohol history
- If B12/folate normal, consider bone marrow evaluation
Scientific Evidence
MCV in Anemia Classification
MCV is the primary method for classifying anemias. Microcytic anemia (MCV <80) is 95% due to iron deficiency or thalassemia. Macrocytic anemia (MCV >100) is 80% due to B12/folate deficiency, alcohol, or liver disease. This classification narrows differential diagnosis and guides targeted testing, dramatically improving diagnostic efficiency.
Source:Hoffbrand AV, et al. Essential Haematology. 7th edition. Wiley-Blackwell. 2016. (PubMed)
Mentzer Index for Thalassemia vs Iron Deficiency
The Mentzer Index (MCV/RBC) distinguishes iron deficiency from thalassemia trait with 90% accuracy when MCV <80. Index >13 suggests iron deficiency (low RBC count, low MCV). Index <13 suggests thalassemia trait (near-normal RBC count despite low MCV). This simple calculation prevents unnecessary iron therapy in thalassemia carriers.
B12 Deficiency and MCV
In B12 deficiency, MCV >110 fL has 95% specificity for megaloblastic anemia. However, 30% of B12-deficient patients have MCV <100 (normocytic) due to concurrent iron deficiency or thalassemia trait masking macrocytosis. Always check B12 if unexplained anemia, regardless of MCV.
Source:Carmel R. How I treat cobalamin (vitamin B12) deficiency. Blood. 2008;112(6):2214-2221.
Alcohol and MCV
Chronic alcohol consumption elevates MCV by 3-10 fL, often in the 100-110 range. This occurs even with normal B12 and folate due to direct marrow toxicity. MCV returns to normal 2-4 months after abstinence, making it useful for monitoring sobriety. However, MCV alone is insufficiently sensitive to screen for alcohol use disorder.
Source:Savage D, et al. Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med. 1994;96(3):239-246.
Iron Deficiency Without Anemia
Iron deficiency initially affects MCV before causing anemia. Falling MCV with normal hemoglobin indicates early iron depletion. This "iron deficiency without anemia"affects 15-20% of menstruating women and benefits from iron supplementation to improve fatigue and cognitive function, even without overt anemia.
Source:Camaschella C. Iron deficiency. Blood. 2019;133(1):30-39.
Which Providers Test MCV, MCH, MCHC?
Full Provider Comparison
| Provider | Includes | Annual Cost | Biomarkers |
|---|---|---|---|
 Superpower | ✓ | $199 | 100+ (150 with ratios) |
 WHOOP Advanced Labs | ✓ | $349 | 65 |
 Labcorp OnDemand | ✓ | $398 | 30+ |
| ✓ | $486 | 40+ | |
| ✓ | $444 | 288 | |
| ✓ | $349 | 100+ | |
| ✓ | $761 | 54 | |
 Function Health | ✓ | $365 | 160+ |
| ✓ | $250 | 65 | |
| ✓ | $495 | 70+ | |
| ✓ | $895 | 100+ | |
| ✓ | $1950 | 150+ | |
| ✓ | $375 | 80+ | |
| — | $Varies | 75+ | |
| ✓ | $190 | 100+ | |
| ✓ | $99 | 50 | |
| — | $124 | 60 | |
| ✓ | $199 | 50 | |
| ✓ | $499 | 120+ | |
| ✓ | $4188 | 70-80+ | |
| ✓ | $375 | 85 | |
| ✓ | $700 | 128 |
Frequently Asked Questions
What is MCV, MCH, MCHC?
Measures of red blood cell size and hemoglobin content
What is the optimal range for MCV, MCH, MCHC?
The standard reference range for MCV, MCH, MCHC is MCV:80-100 fL, MCH:27-33 pg, MCHC:32-36 g/dL. Optimal ranges may differ based on individual health goals and expert recommendations.
Which blood test providers include MCV, MCH, MCHC?
20 out of 22 blood testing providers include MCV, MCH, MCHC in their panels. This biomarker is widely available across major providers.
What category does MCV, MCH, MCHC fall under?
MCV, MCH, MCHC is categorized under Complete Blood Count (CBC). This category includes biomarkers that help assess related aspects of health and wellness.
Medical Disclaimer
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs.
Last reviewed:2026-02-20