MCHC Low or High? Why Your Blood Is Off & Medical Next Steps

If you've been told your MCHC is low or high, you're probably wondering what that means—and whether you should be worried.

MCHC stands for Mean Corpuscular Hemoglobin Concentration. It's a value on your complete blood count (CBC) that measures the average concentration of hemoglobin inside your red blood cells. Hemoglobin is the protein that carries oxygen from your lungs to the rest of your body.

When MCHC is outside the normal range, it usually signals an issue with your red blood cells—most commonly a form of anemia. Let's break down what low or high MCHC means, why it happens, and what to do next.

---

What Is a Normal MCHC?

Most labs consider a normal MCHC range to be:

• 32–36 grams per deciliter (g/dL)

Ranges may vary slightly by laboratory.

If your result is just barely outside the range, it may not be significant. But larger shifts—especially if you have symptoms—deserve attention.

---

What Does Low MCHC Mean?

A low MCHC means your red blood cells have less hemoglobin than normal. These cells often appear "pale" under a microscope and are called hypochromic red blood cells.

Most Common Cause: Iron Deficiency Anemia

The most frequent reason for low MCHC is iron deficiency anemia. Without enough iron, your body can't make enough hemoglobin.

Common causes of iron deficiency:

• Heavy menstrual bleeding
• Pregnancy
• Blood loss (including slow internal bleeding)
• Poor dietary intake
• Digestive disorders affecting absorption (like celiac disease)
• Chronic conditions

Symptoms of low MCHC may include:

• Fatigue
• Weakness
• Shortness of breath
• Pale skin
• Dizziness
• Headaches
• Cold hands and feet

If you're experiencing these symptoms, check your Anemia symptoms using a free AI-powered assessment tool to help identify your risk and prepare for your doctor's visit.

Other Causes of Low MCHC

While iron deficiency is the most common cause, other possibilities include:

• Thalassemia (a genetic blood disorder)
• Chronic disease anemia
• Lead poisoning (rare but possible)
• Long-standing inflammation

Your doctor will look at other lab values—like MCV (mean corpuscular volume), ferritin, and hemoglobin—to determine the underlying cause.

---

What Does High MCHC Mean?

A high MCHC is less common than low MCHC. It means your red blood cells contain a higher concentration of hemoglobin than normal.

Unlike low MCHC, high values are rarely caused by nutritional deficiency.

Common Causes of High MCHC

1. Hereditary Spherocytosis

A genetic condition where red blood cells are round instead of disc-shaped. These cells are more fragile and break down easily.

Symptoms may include:

• Anemia
• Fatigue
• Jaundice (yellowing of skin/eyes)
• Enlarged spleen

2. Autoimmune Hemolytic Anemia

This occurs when the immune system mistakenly attacks red blood cells.

Symptoms can include:

• Rapid fatigue
• Dark urine
• Jaundice
• Shortness of breath

3. Severe Burns

Burn injuries can damage red blood cells and temporarily elevate MCHC.

4. Laboratory Artifact

Sometimes high MCHC is not a true medical problem. It can occur due to:

• Sample handling errors
• Cold agglutinins (a blood-related lab interference)
• Dehydration

This is why repeat testing is sometimes needed.

---

Why MCHC Alone Doesn't Tell the Whole Story

It's important to understand that MCHC is just one part of the CBC. Doctors interpret it alongside:

• Hemoglobin
• Hematocrit
• MCV
• RDW (red cell distribution width)
• Reticulocyte count

For example:

• Low MCHC + Low MCV often suggests iron deficiency.
• High MCHC + signs of hemolysis may point to red cell destruction.

Your doctor looks at the full pattern—not just one number.

---

Medical Next Steps If Your MCHC Is Off

If your MCHC is abnormal, here's what typically happens next:

1. Repeat Testing

Sometimes labs are repeated to confirm results.

2. Iron Studies

If low MCHC is suspected to be iron deficiency, your provider may order:

• Ferritin
• Serum iron
• Total iron-binding capacity (TIBC)
• Transferrin saturation

3. Reticulocyte Count

This measures how quickly your body is producing new red blood cells.

4. Additional Testing (If Needed)

Depending on your situation:

• Vitamin B12 and folate levels
• Hemoglobin electrophoresis (for thalassemia)
• Coombs test (for autoimmune causes)
• Liver function tests
• Evaluation for internal bleeding

5. Treatment Based on Cause

Treatment depends entirely on the underlying issue.

For example:

• Iron deficiency: Oral or IV iron, plus investigation into why iron is low
• Autoimmune causes: Steroids or other immune therapies
• Genetic conditions: Specialist referral
• Bleeding: Identifying and treating the source

It's important not to self-treat with iron unless a doctor confirms you need it. Too much iron can be harmful.

---

When Should You Be Concerned?

Mild changes in MCHC without symptoms are often not urgent.

However, seek medical attention promptly if you experience:

• Chest pain
• Severe shortness of breath
• Fainting
• Rapid heartbeat
• Yellowing of skin or eyes
• Dark urine
• Severe weakness

These could signal significant anemia or active red blood cell destruction and require immediate care.

---

Lifestyle Considerations That Support Healthy Red Blood Cells

If your doctor confirms iron deficiency or nutritional anemia, supportive measures may include:

• Eating iron-rich foods (lean red meat, beans, spinach, fortified cereals)
• Pairing iron with vitamin C for better absorption
• Avoiding excess calcium with iron supplements
• Treating underlying digestive issues
• Managing chronic diseases carefully

But again, treatment should be individualized based on lab findings.

---

The Bottom Line on MCHC

An abnormal MCHC is a signal—not a diagnosis.

• Low MCHC most commonly suggests iron deficiency anemia.
• High MCHC may indicate red blood cell destruction or a hereditary condition.
• The context of your full blood work matters more than a single number.

Most causes of abnormal MCHC are treatable once properly identified. The key is determining why the number is off.

If your results are abnormal or you have symptoms like fatigue, weakness, or shortness of breath, you can use this free Anemia symptom checker to better understand what might be causing your symptoms and prepare informed questions for your healthcare provider.

Most importantly, speak to a doctor about any abnormal lab result—especially if you have concerning symptoms. Some causes of abnormal MCHC can be serious or even life-threatening if left untreated, but with proper medical care, many conditions are manageable and highly treatable.

Your bloodwork is information. The next step is making sure it's interpreted correctly—and acted on wisely.