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MCHC – Mean Corpuscular Hemoglobin Concentration

SI UNITS (recommended)

CONVENTIONAL UNITS

(Average Concentration of Hemoglobin Within a Single Red Blood Cell)

Synonyms

  • MCHC
  • Mean corpuscular hemoglobin concentration
  • Mean cell hemoglobin concentration
  • RBC hemoglobin concentration

Units of Measurement

  • g/dL
  • g/L
  • g/100 mL
  • g%
  • mg/mL
  • mmol/L
  • µmol/L
  • % (used rarely in older literature)

Molecular Weight of Hemoglobin

Hb ≈ 64,500 g/mol

Key Unit Conversions

Mass Units

1 g/dL=10 g/L1\ \text{g/dL} = 10\ \text{g/L}1 g/dL=10 g/L 1 mg/mL=1 g/dL1\ \text{mg/mL} = 1\ \text{g/dL}1 mg/mL=1 g/dL \text{g%} = \text{g/dL} g/100 mL=g/dL\text{g/100 mL} = \text{g/dL}g/100 mL=g/dL

Molar Units

mmol/L=g/L64.5\text{mmol/L} = \frac{\text{g/L}}{64.5}mmol/L=64.5g/L​ µmol/L=g/L0.0645\text{µmol/L} = \frac{\text{g/L}}{0.0645}µmol/L=0.0645g/L​

Example

  • MCHC 33 g/dL
    = 330 g/L
    ≈ 5.12 mmol/L
     ≈ 5120 µmol/L

%

Older conversion:

\text{%} = \text{g/dL} \times 1

So 33 g/dL = 33% (this is outdated but still used in some texts).

Description

MCHC is the average concentration of hemoglobin inside an RBC.
It reflects chromicity (color) of red cells and is essential in anemia classification.

Formula:

\text{MCHC} = \frac{\text{Hemoglobin (g/dL)}}{\text{Hematocrit (L/L)}} \quad \text{or} \quad \text{MCHC} = \frac{\text{Hb (g/dL)}}{\text{Hct (%)}} \times 100

Interpreted together with:

  • MCV
  • MCH
  • RDW
  • Smear morphology

Physiological Role

MCHC is not a biological substance but a diagnostic index that reflects:

  • Efficiency of hemoglobinization
  • Severity of microcytosis/hypochromia
  • Structural RBC defects (e.g., spherocytosis)

Clinical Significance

LOW MCHC

(Most common abnormality)

Causes

  1. Iron Deficiency Anemia (IDA) - hallmark
  2. Thalassemia (trait or major)
  3. Anemia of Chronic Disease (mildly low or normal)
  4. Sideroblastic Anemia
  5. Lead Poisoning
  6. Chronic blood loss
  7. Late pregnancy iron deficiency

Pattern

  • Low MCHC
  • Low MCV
  • Low MCH
  • High RDW (in IDA, not in thalassemia)

Clinical Meaning

Cells contain less hemoglobin per volume, giving a pale (hypochromic) appearance on smear.

HIGH MCHC

(Far less common - important red flag)

Causes

  1. Hereditary Spherocytosis (classic cause)
    • Spherocytes are smaller with higher hemoglobin concentration
  2. Autoimmune Hemolysis (spherocytes formed due to antibody-mediated membrane loss)
  3. Cold agglutinins (false ↑ MCHC due to clumping → low Hct)
  4. Severe Burns
  5. Dehydration (hemoconcentration)
  6. Hyperlipidemia / High bilirubin (laboratory artifact)

Pattern

  • MCHC > 36 g/dL is unusual and suggests:
    • Analytic interference
    • Membrane defect (spherocytosis)
    • Cold agglutinins

Reference Intervals

(WHO + Tietz 8E + Mayo + ARUP)

Adults

  • 32 – 36 g/dL
     (= 320 – 360 g/L)
    (= 4.96 – 5.58 mmol/L)

Children

  • 30 – 36 g/dL

Infants

  • 28 – 36 g/dL

Critical Flags

  • MCHC > 36.5 g/dL → suspect spherocytosis or lab artifact
  • MCHC < 30 g/dL → significant hypochromia (iron deficiency, thalassemia)

Diagnostic Uses

1. Classification of Microcytic Anemia

Low MCHC → iron deficiency or thalassemia.

2. Identify Spherocytosis

High MCHC + spherocytes on smear.

3. Detect Laboratory Artifact

High MCHC suggests:

  • Lipemia
  • Cold agglutinins
  • Severe hyperbilirubinemia

4. Guide Iron Therapy Monitoring

Rising MCHC = improving hemoglobinization.

5. Evaluate Hemolysis

High MCHC with hemolysis markers (LDH, bilirubin, reticulocytes).

Analytical Notes

  • Automated analyzer-derived value
  • Falsely high MCHC occurs in:
    • Cold agglutinins
    • Lipemia
    • Hyperbilirubinemia
  • Falsely low MCHC in severe dilution or marked microcytosis
  • Always confirm with manual smear review if suspicious

Clinical Pearls

  • MCHC rarely exceeds 36 g/dL - when it does, think spherocytosis or cold agglutinins.
  • Low MCHC is the earliest change in iron deficiency.
  • In thalassemia trait: very low MCHC + normal RDW.
  • MCHC normal but MCV low? → early iron deficiency or ACD.
  • Always interpret MCHC with MCV + MCH for full anemia classification.

Interesting Fact

MCHC reflects hemoglobin concentration, not total hemoglobin content - making it the RBC analogue to “hematocrit-adjusted hemoglobin density.”

References

  1. Tietz Clinical Chemistry & Molecular Diagnostics, 8th Edition - Hematology Indices
  2. WHO Hematology Reference Intervals
  3. Mayo Clinic Laboratories - CBC Indices
  4. ARUP Consult - RBC Morphology & CBC Interpretation
  5. MedlinePlus / NIH - RBC Indices

Last updated: January 26, 2026

Reviewed by : Medical Review Board

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