Red Blood Cell Indices Health Article

Definition

Red blood cell (RBC) indices are calculations derived from the complete blood count that aid in the diagnosis and classification of anemia. Measurements needed to calculate indices are the red blood cell count, hemoglobin, and hematocrit. The hematocrit is the percentage of blood by volume that is occupied by the red cells. The three RBC indices are:

• Mean corpuscular volume (MCV). The average size of the red blood cells expressed in femtoliters. MCV is calculated by dividing the hematocrit (as percent) by the RBC count in millions per microliter of blood, then multiplying by 10.
• Mean corpuscular hemoglobin (MCH). The average amount of hemoglobin inside an RBC expressed in picograms. The MCH is calculated by dividing the hemoglobin concentration in grams per deciliter by the RBC count in millions per microliter, then multiplying by 10.
• Mean corpuscular hemoglobin concentration (MCHC). The average concentration of hemoglobin in the RBCs expressed as a percent. It is calculated by dividing the hemoglobin in grams per deciliter by the hematocrit, then multiplying by 100.

Purpose

Red blood cell indices help classify types of anemia, a decrease in the oxygen carrying capacity of the blood. Healthy people have an adequate number of correctly sized red blood cells containing enough hemoglobin to carry sufficient oxygen to all the body's tissues. Anemia is diagnosed when either the hemoglobin or hematocrit of a blood sample is too low.

The mechanisms by which anemia occurs will alter the RBC indices in a predictable manner. Therefore, the RBC indices permit the physician to narrow down the possible causes of an anemia. The MCV is an index of the size of the RBCs. When the MCV is below normal, the RBCs will be smaller than normal and are described as microcytic. When the MCV is elevated, the RBCs will be larger than normal and are termed macrocytic. RBCs of normal size are termed normocytic. Failure to produce hemoglobin results in smaller than normal cells. This occurs in many diseases, including iron deficiency anemia, thalassemia (an inherited disease in which globin chain production is deficient), and anemias associated with chronic infection or disease. Macrocytic cells occur when division of RBC precursor cells in the bone marrow is impaired. The most common causes of macrocytic anemia are vitamin B ₁₂ deficiency, folate deficiency, and liver disease. Normocytic anemia may be caused by decreased production (e.g. malignancy and other causes of bone marrow failure), increased destruction (hemolytic anemia), or blood loss. The RBC count is low, but the size and amount of hemoglobin in the cells are normal.

A low MCH indicates that cells have too little hemoglobin. This is caused by deficient hemoglobin production. Such cells will be pale when examined under the microscope and are termed hypochromic. Iron deficiency is the most common cause of a hypochromic anemia. The MCH is usually elevated in macrocytic anemias associated with vitamin B ₁₂ and folate deficiency.

The MCHC is the ratio of hemoglobin mass in the RBC to cell volume. Cells with too little hemoglobin are lighter in color and have a low MCHC. The MCHC is low in microcytic, hypochromic anemias such as iron deficiency, but is usually normal in macrocytic anemias. The MCHC is elevated in hereditary spherocytosis, a condition with decreased RBC survival caused by a structural protein defect in the RBC membrane.