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Low MCV and MCH: Meaning and Treatment

Medically Approved by Dr. Edward Salko

Table of Contents

Mean corpuscular hemoglobin (MCV) and mean corpuscular hemoglobin (MCH) go hand-in-hand when diagnosing blood disorders and underlying physiological conditions. To have low MCV and MCH means your hemoglobin production is less than normal. As a result, the number of healthy red blood cells also decreases, leading to anemia.

Although anemia is generally not a cause of serious health complications, it becomes a concern when left untreated. You can improve low MCH and MCV by increasing your dietary intake of foods high in iron, folate, and vitamins A and C.

Keep reading to learn more about what to do when you have decreased MCV and MCH. 

What Do Low MCV and MCH Mean?

When your mean corpuscular volume and mean corpuscular hemoglobin are lower than the healthy range, it may indicate iron-deficiency anemia, microcytosis, and thalassemia. MCV and MCH are both parameters measured in a complete blood count (CBC) and a peripheral blood smear. 

The normal ranges for both are as follows:

  • MCV: 80 to 100 fL
  • MCH: 27 to 33 pg/cell

Results from different laboratories may differ slightly. Nonetheless, extremely low MCV and MCH can be traced back to problems involving the red blood cells’ hemoglobin. 

Hemoglobin is a protein that transports oxygen to cells and collects carbon dioxide for release through the lungs. Since hemoglobin is a vital component of RBCs, its deficiency and malformation lead to low erythrocyte count. 

Pro Tip: You may experience serious health complications when your red blood cells are below normal values. The good news is that you can increase your erythrocyte count by improving your diet, taking supplements, and doing other things. Learn more about how to fix low RBC count

Causes of Low MCV and MCH

MCV and MCH, along with other RBC indices, provide information about your hemoglobin and red blood cells, as a whole. If you have both low MCH and MCV, it could indicate the following conditions. 

Microcytic Anemia

People with microcytic anemia have small red blood cells that appear to be paler than they should be – a condition described as hypochromic. Due to a lack of hemoglobin, RBCs shrink in size. Microcytic anemia correlates with the other blood disorders below and inflammatory disease. Notably, it’s linked to iron deficiency. 

Iron-deficiency Anemia

Low MCH and MCV may suggest low intake or malabsorption of iron – a key component in the formation of hemoglobin. Know how serious iron-deficiency anemia can get and find ways to address the condition effectively. 

Did You Know? Women may experience hair loss due to insufficient iron. Unlike men, women tend to lose more iron due to their menstrual cycle. Read more about female hair loss and its connection to iron deficiency. 


Thalassemia is a genetic disorder wherein your body fails to produce enough hemoglobin. It is likely due to a mutated gene passed along to generations. If you have anyone in your family with thalassemia, consider having your MCV and MCH checked, primarily if the condition affects one of your parents.

How Are MCV and MCH Related?

MCV and MCH are red blood cell indices, which are references to evaluate the overall health and quality of red blood cells or erythrocytes. Red blood cell indices measure the erythrocytes’ size, volume, and quality, along with the amount of hemoglobin therein. 

Below is the complete list of RBC indices that help diagnose blood disorders, especially anemia. 

  • Mean corpuscular volume (MCV): refers to the size of red blood cells
  • Mean corpuscular hemoglobin (MCH): the average amount of hemoglobin in an erythrocyte
  • Mean corpuscular hemoglobin concentration (MCHC): measures how much hemoglobin there is in your RBCs per volume
  • Red Cell Distribution Width (RDW): determines how much your red blood cells vary in size and volume

All these other indices are also evaluated, not just MCV and MCH, to ensure an accurate diagnosis of anemia. For example, low MCV, MCH, and MCHC strengthen the evidence of anemia, as they are all influenced by hemoglobin concentration. MCHC should not fall under its normal range of 32 to 36 (d/dL). 

On the other hand, RDW lab values tend to increase in the presence of anemia. In contrast, low RDW poses no critical health issues. Normal RDW should be within 12% to 15%. 

How Can I Improve My Low MCV and MCH?

Treatment for anemia, and by extension – low MCV and MCH, usually involves adjusting your lifestyle and improving your diet. In some cases, your doctor will order additional testing to find the cause of anemia. Either way, the following steps can help normalize your MCV, MCH, and the rest of your red blood cell indices.

Consume more iron-rich foods

Including foods high in iron in your diet is simple as most of these foods already comprise many staple meals. However, the challenge may lie when switching to a vegetarian or vegan lifestyle. In this case, you’ll have to consult with your nutritionist to ensure that you get enough iron from alternatives (non-heme iron). 

According to the National Institutes of Health, the average intake of dietary iron should be as follows: 

  • Children aged 2 to 11: 11.5 to 13.7 mg/day
  • Adolescents aged 12 to19: 15.1 mg/day
  • Adult men: 16.3 to 18.2 mg/day
  • Adult women: 12.6 to 13.5 mg/day

Consider the following iron-rich foods as part of your diet:

  • Red meat (beef, liver, pork loin, etc.)
  • Poultry (chicken meat and eggs)
  • Shellfish (oyster, mussels, clams)
  • Green leafy vegetables (spinach and collard)
  • Legumes (chickpeas, and lentils)
  • Sesame and pumpkin seeds
  • Black beans
  • Edamame 
  • Dried fruits
  • Iron-fortified cereals 

Did You Know? There are two types of iron according to their dietary sources: heme and non-heme iron. Heme can be found solely in animal products, while non-heme are from fruits and vegetables. Research shows that over 95% of functional iron in humans is heme. So if you’re a vegan or planning to be one, you must have a supplemental plan for iron that you discuss with your nutritionist. 

Get more vitamin B12 and folate in your diet

Vitamin B12 and folate (Vitamin B9) are nutrients needed to form healthy red blood cells. Hence, if you have deficiencies in these vitamins, it’s highly likely to develop low MCH and MCV. 

Include the following food sources of vitamin B12 and B9 in your diet:

  • Fish (salmon, tuna, and trout)
  • Meat (beef, pork, and poultry)
  • Leafy greens (spinach, cabbage, and kale)
  • Broccoli 
  • Brussel sprouts 
  • Dairy products
  • Fortified cereals

Consider taking supplements

Add supplements in your diet to compensate iron, and multivitamin deficiencies. Supplements are often recommended if you’re diagnosed with medical conditions that influence the absorption of nutrients. 

Iron tablets are a standard prescription for people with anemia to speed up the normalization of your RBC count and correct abnormalities in your red blood cell indices.

However, it’s important to note that supplements without any deficiency can have side effects on your health. For example, excess intake of oral iron supplements can lead to gastrointestinal issues, increase your risk of infections, and result in iron overload or hemochromatosis. Thus, it’s best to get tested for iron-deficiency anemia first, then consult your doctor on whether you should take supplements and their dosage. 

Take vitamins A and C to improve iron absorption

With enough vitamins A and C in your diet, your ability to absorb iron improves. As a result, healthcare providers may also check on any deficiencies involving these vitamins when assessing iron-deficiency anemia, as well as low RBC indices like MCV, MCH, and MCHC. 

Studies have shown that vitamin C increases gastrointestinal iron absorption, but only when taken in combination with iron supplements and the right dosage. Vitamin C deficiency or scurvy can also lead to anemia. Hence, if you exhibit its symptoms, a vitamin C blood test can help with the diagnosis. 

On the other hand, vitamin A and beta-carotene help in iron absorption by forming a complex with iron. This prevents antinutrients like phytates from counteracting absorption. 

When preparing your diet plan for iron deficiency, consider the following rich sources of vitamins A and C.

Vitamin A and beta-carotene

  • Oily fish (tuna and salmon)
  • Dairy products (cheese, milk, and yogurt)
  • Carrots
  • Apricots 
  • Sweet potatoes
  • Mango 
  • Bell peppers

Vitamin C

  • Citrus fruits (oranges, grapefruit, lemon)
  • Strawberries
  • Potatoes
  • tomatoes
  • Cruciferous vegetables (broccoli, cauliflower, Brussels sprouts)

Avoid iron blockers

Certain substances could inhibit the absorption of iron. They are usually components found in plants that bond to a metal atom in a process called chelation, making the compound unavailable for absorption. Two of the most notable iron blockers or antinutrients are phytates and polyphenols, which can be found in certain foods and drinks. 

Therefore, if you have MCV and MCH below the normal range, regulate the following:

  • Tea
  • Coffee 
  • Cocoa powder
  • Flaxseeds 
  • Pine nuts
  • Walnuts 

Frequently Asked Questions

Is low MCH a concern?

To have a low MCH (<33 pg/cell) in your CBC should be a concern, especially if your MCV, MCHC, and hematocrit blood test show a below-normal result. This indicates problems in the hemoglobin formation of the red blood cells, which characterize anemia. Further testing may be necessary to qualify the type of anemia, which also suggests its severity. 

Should I worry if my MCV is low?

How serious microcytosis becomes depends on what’s causing the condition. A low MCV can be alarming if it’s alongside symptoms of poisoning, specifically lead, which inhibits iron absorption. On the other hand, it can also be due to anemia, which can generally be treated by supplementation and diet adjustment. However, additional treatment may be prescribed if the condition is severe or related to a more serious illness. 

Does MCV decrease with age?

Evidence reveals that MCV increases over time, which shows how the red blood cells grow in volume as you age. In a 2022 study published in the Journal of Cellular and Molecular Medicine, the dataset collected from non-anemic respondents aged 1 to 88 showed an upward linear trend in MCV as age increases.  

The Bottom Line

If your CBC shows low MCV and MCH, you don’t need to immediately rush to the ER. However, it doesn’t mean you should ignore it as well, as it may cause symptoms that can affect your routine. Inform your doctor or a professional provider via a virtual channel about the results. Whether it’s anemia as an isolated condition or a symptom of a more complex illness, make sure you follow through with the recommended diet improvement and/or supplementation.

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