Mean Corpuscular Hemoglobin (MCH)

Other names: Mean RBC Iron, MEAN CORP. HGB, Mean Cell Hb

check icon Optimal Result: 26.6 - 33 pg, 26.6 - 33 pg/cell, or 1.65 - 2.05 fmol.

Reviewed by HealthMatters Editorial Team · Last updated February 2026

What does MCH mean on a blood test?

MCH (Mean Corpuscular Hemoglobin) measures the average amount of hemoglobin inside each red blood cell.

Hemoglobin carries oxygen throughout the body.
MCH helps show how much oxygen each red blood cell can transport.

It is part of a standard Complete Blood Count (CBC) and is interpreted together with:

  • Hemoglobin

  • MCV

  • MCHC

  • RDW

  • Iron levels

MCH alone does not diagnose a condition, but it helps identify patterns of anemia and nutrient deficiency.


MCH normal range

Typical adult reference range:

26–33 picograms (pg) per red blood cell

Ranges vary slightly by lab.
Values just outside the range are common and not always concerning.


What does low MCH mean?

Low MCH means each red blood cell contains less hemoglobin than normal.

This often occurs when red blood cells are smaller or iron levels are low.

Common causes of low MCH

  • Iron deficiency

  • Iron deficiency anemia

  • Chronic blood loss

  • Thalassemia trait

  • Chronic disease

  • Inflammation

Low MCH often appears with:

  • Low MCV

  • Low hemoglobin

  • High RDW

This pattern strongly suggests iron deficiency.


What does high MCH mean?

High MCH means each red blood cell contains more hemoglobin than average.
This usually happens when red blood cells are larger than normal.

Common causes of high MCH

  • Vitamin B12 deficiency

  • Folate deficiency

  • Liver disease

  • Alcohol use

  • Hypothyroidism

  • Certain medications

High MCH often appears with high MCV.


Low MCH but normal hemoglobin

A low MCH with normal hemoglobin can occur early in iron deficiency.

Possible explanations:

  • Early iron depletion

  • Thalassemia trait

  • Mild inflammation

  • Recent illness

Doctors often monitor this pattern and may order iron studies.


High MCH but everything else normal

A mildly elevated MCH with otherwise normal CBC results is common and often not serious.

Possible causes:

  • Mild B12 or folate deficiency

  • Alcohol intake

  • Normal variation

If MCV and hemoglobin are normal, mild elevation alone is usually not concerning.


MCH vs MCV vs MCHC

These red blood cell indices describe different features:

MCV – size of red blood cells
MCH – amount of hemoglobin per cell
MCHC – concentration of hemoglobin in cells
RDW – variation in cell size

Doctors interpret these together to classify anemia.


Symptoms related to abnormal MCH

MCH itself does not cause symptoms.
Symptoms come from the underlying condition (often anemia).

Possible symptoms include:

  • Fatigue

  • Weakness

  • Shortness of breath

  • Pale skin

  • Dizziness

  • Reduced exercise tolerance


When should MCH be evaluated further?

Follow-up is more likely if:

  • Hemoglobin is low

  • MCV is abnormal

  • Iron deficiency is suspected

  • Symptoms are present

  • Results change over time

MCH alone rarely indicates a serious condition.


Key takeaway

MCH measures how much hemoglobin is in each red blood cell.

  • Low MCH often points to iron deficiency

  • High MCH often suggests B12 or folate deficiency

  • MCH is most useful when interpreted with the rest of the CBC

Trends over time are more meaningful than a single result.

What does it mean if your Mean Corpuscular Hemoglobin (MCH) result is too high?

High MCH (above ~33 pg) means each red blood cell contains more hemoglobin than average.

This usually occurs when red blood cells are larger than normal.

Most common causes of high MCH

  • Vitamin B12 deficiency

  • Folate deficiency

  • Liver disease

  • Alcohol use

  • Hypothyroidism

High MCH is most commonly linked to B12 or folate deficiency.


Symptoms associated with high MCH

Symptoms typically reflect the underlying deficiency.

Common symptoms:

  • Fatigue

  • Weakness

  • Pale skin

  • Shortness of breath

If caused by vitamin B12 deficiency, additional symptoms may include:

  • Tingling or numbness

  • Balance problems

  • Memory changes


What to do if your MCH is high

Doctors may evaluate:

  • Vitamin B12 levels

  • Folate levels

  • Thyroid function

  • Liver function

Treatment depends on the cause and may include:

  • Vitamin B12 supplementation

  • Folate supplementation

  • Reducing alcohol intake

  • Managing thyroid or liver conditions

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What does it mean if your Mean Corpuscular Hemoglobin (MCH) result is too low?

Low MCH (below ~26–27 pg) means each red blood cell contains less hemoglobin than normal.

This usually happens when red blood cells are smaller or iron levels are low.

Most common causes of low MCH

  • Iron deficiency

  • Iron deficiency anemia

  • Chronic blood loss (menstruation, GI bleeding)

  • Thalassemia trait

  • Chronic inflammatory disease

Low MCH is most often linked to iron deficiency.


Symptoms associated with low MCH

MCH itself does not cause symptoms.
Symptoms come from the underlying anemia.

Possible symptoms:

  • Fatigue

  • Weakness

  • Shortness of breath

  • Pale skin

  • Dizziness

  • Cold hands and feet

Some people have no symptoms, especially in early iron deficiency.


What to do if your MCH is low

Doctors may order:

  • Iron studies (ferritin, iron, transferrin saturation)

  • MCV and RDW review

  • B12 or folate testing (if indicated)

Treatment depends on the cause and may include:

  • Iron supplementation

  • Addressing blood loss

  • Treating underlying chronic disease

Low MCH improves once the underlying cause is corrected.

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