Table of ContentsView AllTable of ContentsCBCRBCMCHCMCVMCHRDW
Table of ContentsView All
View All
Table of Contents
CBC
RBC
MCHC
MCV
MCH
RDW
As valuable as the tests are, understanding what a high RBC, low MCV, or low MCH mean can be difficult and confusing. But, with a little insight and education, you can make sense of the different tests and participate more actively in your healthcare decisions.
This article breaks down the various tests that make up the RBC indices, including what high and low test values mean. It also gives examples of commonly accepted reference ranges.
Science Photo Library / SCIEPRO / Getty Images
What Is a Complete Blood Count?
The CBC not only includes white blood cells (leukocytes) that help fight infection and platelets (thrombocytes) that clot blood but also red blood cells (erythrocytes) that transport oxygen throughout the body
In their totality, these values can tell a healthcare provider a lot about the state of your health.
Routine Blood Tests Everyone Should Know
How to Read a Blood Test Report
The first step in learning how to read any blood test report is to understand thereference ranges of values. This is the set of values between which a blood test result is considered normal. It is validated through testing patients.
Simply put:
It’s important to note that high and low values are “abnormal” but, on their own, don’t necessarily mean anything until they are investigated further with other blood, lab, or imaging tests.
The reference range is based on the expected values within a given population. As such, the values can vary from one population to the next or sometimes even from one lab to the next.Reference ranges may also vary depending on the equipment and testing methods used. That said, always refer the laboratory-specific reference values provided with your results.
The reference range is based on the expected values within a given population. As such, the values can vary from one population to the next or sometimes even from one lab to the next.
Reference ranges may also vary depending on the equipment and testing methods used. That said, always refer the laboratory-specific reference values provided with your results.
By way of example,hemoglobinvalues (used in part to detectanemia) are invariably higher at high altitudes than they are at sea level, and are a normal adaptation. Therefore, not only does the reference range for hemoglobin differ but so does the diagnostic definition of anemia.
1:53Click Play to Learn All About Red Blood Cell Indices
1:53
Click Play to Learn All About Red Blood Cell Indices
Red Blood Cell (RBC) Count
Thered blood cell (RBC) countis the general starting point of any evaluation of red blood cells. As per its name, it simply counts the number of red blood cells in a sample of blood. The RBC count is measured in millions of cells per microliter (one-millionth of a liter), or cells/mcL.
A normal RBC count depends on age and sex:
A low and high RBC count can mean any number of things, both benign and severe.
Possible Causes of a Low and High RBC CountLow RBCAnemiaVitamin deficiencyCertain medications (such aschemotherapy)Bleeding in the digestive tract (such as apeptic ulcer)Heavy menstrual bleedingHypothyroidism(low thyroid function)Chronic kidney disease (CKD)Inflammatory bowel disease (IBD)Rheumatoid arthritis (RA)Liver cirrhosisCertain cancers, includinglymphomaandleukemiaHigh RBCDehydrationHeart failureChronic obstructive pulmonary disease (COPD)Pulmonary fibrosis(scarring of lung tissue)Polycythemia vera(a bone marrow disease)Performance-enhancing drugs (such asanabolic steroids)Renal cell carcinoma(a type of kidney cancer)
Possible Causes of a Low and High RBC Count
Low RBCAnemiaVitamin deficiencyCertain medications (such aschemotherapy)Bleeding in the digestive tract (such as apeptic ulcer)Heavy menstrual bleedingHypothyroidism(low thyroid function)Chronic kidney disease (CKD)Inflammatory bowel disease (IBD)Rheumatoid arthritis (RA)Liver cirrhosisCertain cancers, includinglymphomaandleukemia
Anemia
Vitamin deficiency
Certain medications (such aschemotherapy)
Bleeding in the digestive tract (such as apeptic ulcer)
Heavy menstrual bleeding
Hypothyroidism(low thyroid function)
Chronic kidney disease (CKD)
Inflammatory bowel disease (IBD)
Rheumatoid arthritis (RA)
Liver cirrhosis
Certain cancers, includinglymphomaandleukemia
High RBCDehydrationHeart failureChronic obstructive pulmonary disease (COPD)Pulmonary fibrosis(scarring of lung tissue)Polycythemia vera(a bone marrow disease)Performance-enhancing drugs (such asanabolic steroids)Renal cell carcinoma(a type of kidney cancer)
Dehydration
Heart failure
Chronic obstructive pulmonary disease (COPD)
Pulmonary fibrosis(scarring of lung tissue)
Polycythemia vera(a bone marrow disease)
Performance-enhancing drugs (such asanabolic steroids)
Renal cell carcinoma(a type of kidney cancer)
What Are Red Blood Cell (RBC) Indices?
Along with the RBC count, theRBC indicesprovide information about the quality of your red blood cells. The RBC indices look at specific components or characteristics of red blood cells, including their size and proportion.
The RBC indices also look at a protein in red blood cells calledhemoglobinthat is responsible for transporting oxygen from the lungs to the rest of the body. Hemoglobin is also the protein that gives red blood cells their red color.
The main components of the RBC indices include the mean corpuscular hemoglobin concentration (MCHC), the mean corpuscular volume (MCV), the mean corpuscular hemoglobin (MCH), and the red cell distribution width (RDW).
Mean Corpuscular Hemoglobin Concentration (MCHC)
Themean corpuscular hemoglobin concentration (MCHC)is the average concentration of hemoglobin in a sample of red blood cells. Acorpuscleis simply a term used to describe a living cell, particularly red and white blood cells.
The MCHC basically tells whether you have more or less hemoglobin than what would be expected. The MCHC is measured in grams of hemoglobin per deciliter (one-thousandths of a liter) of blood, or g/dL.
A normal reference range for MCHC is between 32 and 36 g/dL in adults.
Low and high MCHC can mean any number of different things,however, an abnormal MCHC is not significant if there is no anemia.
How Anemia Is Treated
Mean Corpuscular Volume (MCV)
Mean corpuscular volume (MCV)measures the average volume of red blood cells. Any increase or decrease in the normal volume/size of a red blood cell can affect its ability to transport oxygen, leading to anemia. The MCV is measured in femtoliters (one thousand trillionths of a liter) per cell, or fL/cell.
A normal reference range for MCV is between 80 and 96 fL/cell.
Low and high MCV values can mean any number of things:
It’s important to note that a person can have anemia and have a normal MCV. This is callednormocytic anemia. Causes may include:
Possible Causes of a Low or High MCVLow MCVIron deficiencyLead poisoningIron malabsorptionThalassemiaAnemia of chronic diseaseCopper deficiencyHigh MCVHemolytic anemiaVitamin B12 deficiencyFolate deficiencyLiver diseaseAlcoholismHypothyroidismLeukemiaChemotherapyCopper deficiency
Possible Causes of a Low or High MCV
Low MCVIron deficiencyLead poisoningIron malabsorptionThalassemiaAnemia of chronic diseaseCopper deficiency
Iron deficiency
Lead poisoning
Iron malabsorption
Thalassemia
Anemia of chronic disease
Copper deficiency
High MCVHemolytic anemiaVitamin B12 deficiencyFolate deficiencyLiver diseaseAlcoholismHypothyroidismLeukemiaChemotherapyCopper deficiency
Hemolytic anemia
Vitamin B12 deficiency
Folate deficiency
Liver disease
Alcoholism
Hypothyroidism
Leukemia
Chemotherapy
Mean Corpuscular Hemoglobin (MCH)
Mean corpuscular hemoglobin (MCH)is the average amount of hemoglobin per red blood cell in a sample of blood. MCH is measured in picograms (one trillionth of a gram) per cell, or pg/cell.
A normal reference range for MCH is between 27 and 32 pg/cell.
The possible causes of low and high MCH tend to echo those of a low and high MCHC.
Red Cell Distribution Width (RDW)
Red cell distribution width (RDW)is a test that assesses the variability in the size of the red blood cells.A normal RDW would mean that your red blood cells are all similar in size, whereas a higher RDW means that there is more variability in the size of the red blood cells. This is calledanisocytosis.
RDW values are described in percentages. It is instead calculated as the standard deviation of red blood cell volume/mean cell volume) × 100.
A normal reference range for RDW is 11.5% to 14.5%.
A low RDW means that red blood cells are not very different in size from typical measurements. A high RDW means they differ in size more significantly, which can indicate the body is having trouble producing enough red blood cells.
The interpretation of the RDW differs from the other blood tests in that it varies based on its relationship to the MCV. In short, the sizes and variability of red blood cells can indicate vastly different things.
Here are just a handful of examples:
RDW ResultMCV ResultPossible CausesHighHighVitamin B12 deficiencyFolate deficiencyHemolytic anemiaCoronary artery diseasePeripheral artery diseaseMyelodysplastic syndromesHighLowIron deficiency anemiaIron malabsorptionSickle cell diseaseHighNormalIron deficiency anemiaChronic internal bleedingNormalHighAplastic anemiaAlcoholismLiver cirrhosisLiver cancerNormalLowAnemia of chronic diseaseThalassemiaList Common and Uncommon Blood DisordersSummaryRed blood cell (RBC) indices are a battery of tests that evaluate measurable characteristics of red blood cells, including their size and the concentration of hemoglobin in them. The tests include the mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and red cell distribution width (RDW).The test values can point a healthcare provider in the direction of the possible causes when compared to each other or to other blood, lab, or imaging test results.Ways to Increase Your Red Blood Cell Count
List Common and Uncommon Blood Disorders
Summary
Red blood cell (RBC) indices are a battery of tests that evaluate measurable characteristics of red blood cells, including their size and the concentration of hemoglobin in them. The tests include the mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and red cell distribution width (RDW).
The test values can point a healthcare provider in the direction of the possible causes when compared to each other or to other blood, lab, or imaging test results.
Ways to Increase Your Red Blood Cell Count
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.NIH MedlinePlus.Complete blood count (CBC).George TI.Automated complete blood count (CBC).UptoDate.Gassman M, Mairbaurl H, Livshits L.The increase in hemoglobin concentration with altitude varies among human populations.Ann N Y Acad Sci. 2019 Aug;1450(1):204-20. doi:10.1111/nyas.14136Alomari YM, Sheikh abdullah SN, Zaharatul azma R, Omar K.Automatic detection and quantification of WBCs and RBCs using iterative structured circle detection algorithm.Comput Math Methods Med. 2014;2014:979302. doi:10.1155/2014/979302MedlinePlus.Red blood cell (RBC) indices.Karakochuk CD, Hess SY, Moorthy D, et al.Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review.Ann N Y Acad Sci. 2019;1450(1):126-146. doi:10.1111/nyas.14003NIH MedlinePlus.RBC Indices.Cook S.Increased mean cell hemoglobin concentration.Clin Chem. 2022;68(6):861-862. doi:10.1093/clinchem/hvab253MedlinePlus.RBC indices.UCSF.RBC indices.Dasgupta A.Chapter 4 - Alcohol biomarkers: an overview. In: Dasgupta, A, ed.Alcohol and Its Biomarkers. San Diego: Elsevier, 2015:91-120. doi:10.1016/B978-0-12-800339-8.00004-3Kwon H, Park B.Borderline-high mean corpuscular volume levels are associated with arterial stiffness among the apparently healthy Korean individuals.Korean J Fam Med. 2020;41(6):387-391. doi:10.4082/kjfm.19.0061Nagao T, Hirokawa M.Diagnosis and treatment of macrocytic anemias in adults.J Gen Fam Med.2017;18(5):200-204. doi:10.1002/jgf2.31Huang YL, Hu ZD.Lower mean corpuscular hemoglobin concentration is associated with poorer outcomes in intensive care unit admitted patients with acute myocardial infarction.Ann Transl Med. 2016;4(10):190. doi:10.21037/atm.2016.03.42Huang P, Liu C, Li B, et al.Preoperative mean corpuscular hemoglobin affecting long-term outcomes of hepatectomized patients with hepatocellular carcinoma.Mol Clin Oncol.2016;4(2):229-236. doi:10.3892/mco.2015.705Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB.Red cell distribution width and all-cause mortality in critically ill patients.Crit Care Med.2011;39(8):1913-21. doi:10.1097/CCM.0b013e31821b85c6Bujak K, Wasilewski J, Osadnik T, et al.The prognostic role of red blood cell distribution width in coronary artery disease: a review of the pathophysiology.Dis Markers. 2015;2015:824624. doi:10.1155/2015/824624Lippi G, Turcato G, Cervellin G, Sanchis-Gomar F.Red blood cell distribution width in heart failure: A narrative review.World J Cardiol. 2018;10(2):6-14. doi:10.4330/wjc.v10.i2.6NIH MedlinePlus.RDW (Red Cell Distribution Width).
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.NIH MedlinePlus.Complete blood count (CBC).George TI.Automated complete blood count (CBC).UptoDate.Gassman M, Mairbaurl H, Livshits L.The increase in hemoglobin concentration with altitude varies among human populations.Ann N Y Acad Sci. 2019 Aug;1450(1):204-20. doi:10.1111/nyas.14136Alomari YM, Sheikh abdullah SN, Zaharatul azma R, Omar K.Automatic detection and quantification of WBCs and RBCs using iterative structured circle detection algorithm.Comput Math Methods Med. 2014;2014:979302. doi:10.1155/2014/979302MedlinePlus.Red blood cell (RBC) indices.Karakochuk CD, Hess SY, Moorthy D, et al.Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review.Ann N Y Acad Sci. 2019;1450(1):126-146. doi:10.1111/nyas.14003NIH MedlinePlus.RBC Indices.Cook S.Increased mean cell hemoglobin concentration.Clin Chem. 2022;68(6):861-862. doi:10.1093/clinchem/hvab253MedlinePlus.RBC indices.UCSF.RBC indices.Dasgupta A.Chapter 4 - Alcohol biomarkers: an overview. In: Dasgupta, A, ed.Alcohol and Its Biomarkers. San Diego: Elsevier, 2015:91-120. doi:10.1016/B978-0-12-800339-8.00004-3Kwon H, Park B.Borderline-high mean corpuscular volume levels are associated with arterial stiffness among the apparently healthy Korean individuals.Korean J Fam Med. 2020;41(6):387-391. doi:10.4082/kjfm.19.0061Nagao T, Hirokawa M.Diagnosis and treatment of macrocytic anemias in adults.J Gen Fam Med.2017;18(5):200-204. doi:10.1002/jgf2.31Huang YL, Hu ZD.Lower mean corpuscular hemoglobin concentration is associated with poorer outcomes in intensive care unit admitted patients with acute myocardial infarction.Ann Transl Med. 2016;4(10):190. doi:10.21037/atm.2016.03.42Huang P, Liu C, Li B, et al.Preoperative mean corpuscular hemoglobin affecting long-term outcomes of hepatectomized patients with hepatocellular carcinoma.Mol Clin Oncol.2016;4(2):229-236. doi:10.3892/mco.2015.705Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB.Red cell distribution width and all-cause mortality in critically ill patients.Crit Care Med.2011;39(8):1913-21. doi:10.1097/CCM.0b013e31821b85c6Bujak K, Wasilewski J, Osadnik T, et al.The prognostic role of red blood cell distribution width in coronary artery disease: a review of the pathophysiology.Dis Markers. 2015;2015:824624. doi:10.1155/2015/824624Lippi G, Turcato G, Cervellin G, Sanchis-Gomar F.Red blood cell distribution width in heart failure: A narrative review.World J Cardiol. 2018;10(2):6-14. doi:10.4330/wjc.v10.i2.6NIH MedlinePlus.RDW (Red Cell Distribution Width).
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
NIH MedlinePlus.Complete blood count (CBC).George TI.Automated complete blood count (CBC).UptoDate.Gassman M, Mairbaurl H, Livshits L.The increase in hemoglobin concentration with altitude varies among human populations.Ann N Y Acad Sci. 2019 Aug;1450(1):204-20. doi:10.1111/nyas.14136Alomari YM, Sheikh abdullah SN, Zaharatul azma R, Omar K.Automatic detection and quantification of WBCs and RBCs using iterative structured circle detection algorithm.Comput Math Methods Med. 2014;2014:979302. doi:10.1155/2014/979302MedlinePlus.Red blood cell (RBC) indices.Karakochuk CD, Hess SY, Moorthy D, et al.Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review.Ann N Y Acad Sci. 2019;1450(1):126-146. doi:10.1111/nyas.14003NIH MedlinePlus.RBC Indices.Cook S.Increased mean cell hemoglobin concentration.Clin Chem. 2022;68(6):861-862. doi:10.1093/clinchem/hvab253MedlinePlus.RBC indices.UCSF.RBC indices.Dasgupta A.Chapter 4 - Alcohol biomarkers: an overview. In: Dasgupta, A, ed.Alcohol and Its Biomarkers. San Diego: Elsevier, 2015:91-120. doi:10.1016/B978-0-12-800339-8.00004-3Kwon H, Park B.Borderline-high mean corpuscular volume levels are associated with arterial stiffness among the apparently healthy Korean individuals.Korean J Fam Med. 2020;41(6):387-391. doi:10.4082/kjfm.19.0061Nagao T, Hirokawa M.Diagnosis and treatment of macrocytic anemias in adults.J Gen Fam Med.2017;18(5):200-204. doi:10.1002/jgf2.31Huang YL, Hu ZD.Lower mean corpuscular hemoglobin concentration is associated with poorer outcomes in intensive care unit admitted patients with acute myocardial infarction.Ann Transl Med. 2016;4(10):190. doi:10.21037/atm.2016.03.42Huang P, Liu C, Li B, et al.Preoperative mean corpuscular hemoglobin affecting long-term outcomes of hepatectomized patients with hepatocellular carcinoma.Mol Clin Oncol.2016;4(2):229-236. doi:10.3892/mco.2015.705Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB.Red cell distribution width and all-cause mortality in critically ill patients.Crit Care Med.2011;39(8):1913-21. doi:10.1097/CCM.0b013e31821b85c6Bujak K, Wasilewski J, Osadnik T, et al.The prognostic role of red blood cell distribution width in coronary artery disease: a review of the pathophysiology.Dis Markers. 2015;2015:824624. doi:10.1155/2015/824624Lippi G, Turcato G, Cervellin G, Sanchis-Gomar F.Red blood cell distribution width in heart failure: A narrative review.World J Cardiol. 2018;10(2):6-14. doi:10.4330/wjc.v10.i2.6NIH MedlinePlus.RDW (Red Cell Distribution Width).
NIH MedlinePlus.Complete blood count (CBC).
George TI.Automated complete blood count (CBC).UptoDate.
Gassman M, Mairbaurl H, Livshits L.The increase in hemoglobin concentration with altitude varies among human populations.Ann N Y Acad Sci. 2019 Aug;1450(1):204-20. doi:10.1111/nyas.14136
Alomari YM, Sheikh abdullah SN, Zaharatul azma R, Omar K.Automatic detection and quantification of WBCs and RBCs using iterative structured circle detection algorithm.Comput Math Methods Med. 2014;2014:979302. doi:10.1155/2014/979302
MedlinePlus.Red blood cell (RBC) indices.
Karakochuk CD, Hess SY, Moorthy D, et al.Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review.Ann N Y Acad Sci. 2019;1450(1):126-146. doi:10.1111/nyas.14003
NIH MedlinePlus.RBC Indices.
Cook S.Increased mean cell hemoglobin concentration.Clin Chem. 2022;68(6):861-862. doi:10.1093/clinchem/hvab253
MedlinePlus.RBC indices.
UCSF.RBC indices.
Dasgupta A.Chapter 4 - Alcohol biomarkers: an overview. In: Dasgupta, A, ed.Alcohol and Its Biomarkers. San Diego: Elsevier, 2015:91-120. doi:10.1016/B978-0-12-800339-8.00004-3
Kwon H, Park B.Borderline-high mean corpuscular volume levels are associated with arterial stiffness among the apparently healthy Korean individuals.Korean J Fam Med. 2020;41(6):387-391. doi:10.4082/kjfm.19.0061
Nagao T, Hirokawa M.Diagnosis and treatment of macrocytic anemias in adults.J Gen Fam Med.2017;18(5):200-204. doi:10.1002/jgf2.31
Huang YL, Hu ZD.Lower mean corpuscular hemoglobin concentration is associated with poorer outcomes in intensive care unit admitted patients with acute myocardial infarction.Ann Transl Med. 2016;4(10):190. doi:10.21037/atm.2016.03.42
Huang P, Liu C, Li B, et al.Preoperative mean corpuscular hemoglobin affecting long-term outcomes of hepatectomized patients with hepatocellular carcinoma.Mol Clin Oncol.2016;4(2):229-236. doi:10.3892/mco.2015.705
Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB.Red cell distribution width and all-cause mortality in critically ill patients.Crit Care Med.2011;39(8):1913-21. doi:10.1097/CCM.0b013e31821b85c6
Bujak K, Wasilewski J, Osadnik T, et al.The prognostic role of red blood cell distribution width in coronary artery disease: a review of the pathophysiology.Dis Markers. 2015;2015:824624. doi:10.1155/2015/824624
Lippi G, Turcato G, Cervellin G, Sanchis-Gomar F.Red blood cell distribution width in heart failure: A narrative review.World J Cardiol. 2018;10(2):6-14. doi:10.4330/wjc.v10.i2.6
NIH MedlinePlus.RDW (Red Cell Distribution Width).
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.Cookies SettingsAccept All Cookies
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.
Cookies SettingsAccept All Cookies
