Mean corpuscular hemoglobin concentration

hemoglobin

The mean corpuscular hemoglobin concentration, or MCHC, is a measure of the concentration of hemoglobin in a given volume of packed red blood cells. It is reported as part of a standard complete blood count.

It is calculated by dividing the hemoglobin by the hematocrit. Reference ranges for blood tests are 32 to 36 g/dl,^[1] or between 4.9 ^[2] to 5.5^[2] mmol/L. It is thus a mass or molar concentration. Still, many instances^[3][4] measure MCHC in percentage (%), as if it was a mass fraction (m_Hb / m_RBC). Numerically, however, the MCHC in g/dl and the mass fraction of hemoglobin in red blood cells in % are identical, assuming a RBC density of 1g/mL and negligible hemoglobin in plasma.

Interpretation

MCHC is diminished ("hypochromic") in microcytic anemias, and normal ("normochromic") in macrocytic anemias (due to larger cell size, though the hemoglobin amount or MCH is high, the concentration remains normal). MCHC is elevated ("hyperchromic") in hereditary spherocytosis, sickle cell disease and homozygous hemoglobin C disease.^[5]

This count is used to give a rough guide to what shade of red, RBC will be. (paler=lower than the standard)

Complications with cold agglutinin

Because of the way automated analysers count blood cells, a very high MCHC (greater than about 370 g/L) may indicate the blood is from someone with a cold agglutinin. This means that when their blood gets colder than 37°C it starts to clump together. As a result, the analyzer may incorrectly report a low number of very dense red blood cells for blood samples in which agglutination has occurred.

This problem is usually picked up by the laboratory before the result is reported. The blood is warmed until the cells separate from each other, and quickly put through the machine while still warm.This is the most sensitive test for iron deficiency anemia.

There are 4 steps to perform when an increase MCHC(>370 g/L or 37.0 g/dL) is received from the analyzer:

• 1. Remix the EDTA tube - if the MCHC corrects, report corrected results
• 2. Incubation at 37°C - if the MCHC corrects, report corrected results and comment on possible cold agglutinin
• 3. Saline replacement - Replace plasma with same amount of Saline to exclude interference eg. Lipemia and Auto-immune antibodies - if the MCHC corrects, report corrected results and comment on Lipemia
• 4. Check the slide for Spherocytosis (eg. in Hereditary spherocytosis, among other causes)

Worked example

Measure	Units	Conventional units	Conversion
Hct	40%
Hb	100 grams/liter	10 grams/deciliter	(deci- is 10-1)
RBC	5E+12 cells/liter	5E+12 cells/liter
MCV = Hct / RBC	8E-14 liters/cell	80 femtoliters/cell	(femto- is 10-15)
MCH = Hb / RBC	2E-11 grams/cell	20 picograms/cell	(pico- is 10-12)
MCHC = Hb / HCT	250 grams/liter	25 grams/deciliter	(deci is 10-1)

See also

• Red blood cell indices
  • Mean corpuscular volume
  • Mean corpuscular hemoglobin

References

1. ^ http://www.nlm.nih.gov/medlineplus/ency/article/003648.htm
2. ^ ^{a b} Derived from mass concentration, using molar mass of 64,458 g/mol (Van Beekvelt MC, Colier WN, Wevers RA, Van Engelen BG (2001). "Performance of near-infrared spectroscopy in measuring local O2 consumption and blood flow in skeletal muscle". J Appl Physiol 90 (2): 511–519. PMID 11160049. ). 1 g/dL = 0.1551 mmol/L
3. ^ Blood Test Results - Normal Ranges Bloodbook.Com. Retrieved on Jan 7, 2009
4. ^ MedicineNet > Definition of MCHC Last Editorial Review: 7/21/1999
5. ^ Rifkind, David; Cohen, Alan S. (2002). The Pediatric Abacus. Informa Healthcare. pp. 54. ISBN 1-84214-147-3. 

External links

• FP Notebook
• Cornell
• Medline