Jan 30, 2012

What is MCH and why is mine always high?

Looking back through four years of lab results, I noticed that one test has almost always come back flagged as "high" - MCH.

Now, I admit, it hasn't been very high, just one or two points over the top of the range, but given that we've turned over just about every rock looking for the source of my fatigue, what if this is the one we've missed?

So I asked my family practitioner why she thought it was constantly elevated. She said that it was likely due to consuming alcohol. *rolls eyes* As anyone with fatigue will understand, drinking alcohol is strictly a special-occassion-one-glass kind of thing, as it puts me to sleep almost instantly.

"Honestly, Penelope...We can't follow every trail you find in your lab results", she said in her usual annoyed voice, "some people just have a higher level than others".

Well...OK, but when I feel AWFUL for years, do you think we could just consider that it might be meaningful?

So, other than knowing that MCH means Mean Corpuscular Hemoglobin, what does it indicate (other than alcohol abuse) and is it really normal to be out of range for years on end?

Is it wrong that I'm pissed off at her non-answer?


  1. I don't think it's wrong to be pissed off at all. Your doctor was very dismissive of you, which is never a good feeling for a patient (or an appropriate response). I can relate to her frustration, as it's frustrating at times to not be able to figure out what's going on with a patient, but it's still important for doctors to not externalize that frustration on their patients.

    As for the causes of an increased MCH, there are quite a few. Some of the more common include vitamin B12 deficiency, folate deficiency, hypothyroidism, alcohol abuse (which you've already established isn't the case!), liver failure, bone marrow disorders (usually in the presence of multiple other abnormalities on the CBC), and COPD. The important thing to remember about any lab value, however, is that "normal" ranges are determined to encompass 95% of the general population, therefore 5% of the population will have an abnormal lab value despite being completely "normal". Having a high MCV in isolation doesn't necessarily mean anything, particularly if the various causes of a high MCV have already been ruled out.

    Please note that this is just a generic answer, and in no way is medical advice! (Have to add in that disclaimer.)

  2. Hi SolitaryD,
    Thanks for the very informative (and not-at-all-to-be-construed-as-medical-advice!) response.

    My physician's frustrations are understandable, she has looked dozens of possibilities and still not found answers for me.

    I just hate that I feel like I'm taking up too much of her time. One of the reasons I joined a concierge medical clinic was to have more access to my doctor.

    I wish I could pay for an hour with a doctor, just to talk freely and have my questions answered.

    Unfortunately, our system doesn't allow that option; which is too bad, because 10 minute visits are better suited for tonsillitis, rather than mystery ailments.

    :-) P.

    1. Penelope, my MCH was high for years, and I wondered the same thing. I would also have low RBCs many times as well. My thyroid TSH test would be all over the place, sometimes over 10, other times below one, with my thyroid hormone being changed to different types and constantly being regulated up and down every 8 weeks. Then 18 months ago, I started to become very, very ill. Now I questioned all of these test results before becoming very ill and I got the same roll your eyes looks from many, many doctors. I am a retired reserach nurse who worked for many years at the University of Chicago and I was treated no different, at times worse because I had the nerve to constantly question my blood work. Part of my nursing was working on an oncology autologous stem cell transplant unit as well. And to top things off to make my doctors more aggravated with me, I am a 17 year breast cancer survivor. I have been plagued with health issues since my cancer. I have had spinal cord degeneration requiring 4 spinal cord surgeries and have had my gallbladder removed. I have been in and out of the hospital for medication reactions as well, strange rashes. As this past year went by, it has been a horror! I became extremely lethargic, my hair started falling out, my abdomin swelled becoming very painful, severe leg pain, headaches, I mean knock down severe headaches, joint and back pain worse than my usual, then my eyes started to hurt, and I became sensitive to the sun. I live in Florida on the beach and I cannot go outside in the sun after 10 am or before 5 pm. It was then determined my iron saturation was low, so I received 10 IV iron treatments. I only got worse. With each weekly treatment I gained 3 to 5 lbs., my leg pain was so severe I could hardly handle it even with narcotic pain medication. The photo and sun sensitivity increased and I became even more edematous, with high blood pressure and tachycardia. Several blood pressure meds have not worked. So then I started getting B12 injections, as high MCH can mean B12 deficiency. I received 8 weekly and now get one a month and was told I would need them the rest of my life. But I am getting worse. Vitamin and mineral deficiencies are adding up. I take high dose prescription Vitamin D and need supplements for many more after micronutrient testing indicated I was severely deficient in other nutrients, even though I eat extremely well, according to Dr. Andrew Weil's anti-inflammatory diet. It was thought I had Lupus because my symptoms just keep piling up. So I started supplementation for Lupus symptoms but still am not better. My doctors, primary care, oncologist, neurologist, gastroenterologist, cardiologist, and rhematologist have given up on me. So I am now seeing an immunologist. It is now suspected that I have a red blood cell disorder of some type. Right now it is leaning towards Porphyria, a rare disorder where the body does not produce enzymes to make the heme in hemaglobin. If I have that, then I should not have received iron treatments. I did what is called a urine poor man's test for Porphyria. If the urine is exposed to sunlight and turns dark it is considered you may have the disease. Mine did turn dark. I have been tested blood and urin for this disease and will see the doctor this coming Friday for the results. But it all started with me having high MCH on my labs for years, then my thyroid tests being off and then it kept advancing. I hope you do not give up. Get another doctor if you have to. I am going to be 60 next year and want to live a life without pain. I wish I would have caught this sooner. Good luck to you.

    2. I was reading this: http://articles.mercola.com/sites/articles/archive/2012/10/02/dr-huggins-discusses-root-canals.aspx

    3. just curious...you say you are a breast cancer survivor. Might you have silicone implants - many of the symptoms you describe are the same that I have come across for silicone toxicity - I know the belief is they don't cause problems but I believe mine are causing me problems just like you describe. Maybe it could help get your life back...

  3. well solitary has a good start on it. Those factors are more likely to alter MCV (mean corpuscular volume) in a detetcable way; often the MCH doesn't seem to change appreciably. Basically, if you don't have the stuff you need to make the cell wall (eg. folate) then you make bigger cells and pack more stuff into them (so you have a larger mean cell volume).

    If you were acutely anemic and started making a lot of new cells, you might have lots of large, packed ones... but you'll see a wide RDW errrr this is getting complicated... variance in cell size, basically. But anyway, you'd have other abnormalities on the test aside from a big MCV or MCH.

    MCH is kiiiind of the same thing but looks at how much hemoglobin is packed in to each cell. This is a calculated not a straight-up measured value. They just divide the Hemoglobin by the RBC - so if your Hb is on the higher end of normal and your RBCs are on the lower end of normal, it could look like you have a big MCH.

    Clinically this is rarely relevant and certainly used less often than an MCV. Being a calculated value I think as long as your other indexes are normal, there would never be a reason (or even a way) to further investigate this.

  4. oh looking back at it, that's a terrible explanation! if you were in the office, I'd draw you a picture. That's so much easier :)

    1. Hi just got back my blood test results my RBC is low and my MCH is high, any suggestions Docotr :)

  5. I wish I were in your office! Pictures do say a thousand words, don't they?

    You and SolitaryD have given me a good starting place to think about my results.

    I'm actually wondering if I could have the MTHFR mutation. I'm wondering if one reason for having higher MCV & MCH levels could be not having enough available folic acid to build new cells?

    Between my Factor V Leiden, super-low ferritin levels, and treatment resistant depression... I'm thinking it might be worth it to take the genetic test (if I can find it in Canada) and see if my body is making usable folic acid.

    Thanks again for shedding some light on this lab result.

  6. Praying you find answers soon - and perhaps a more understanding doctor?


  7. Thanks Jamie, I'm praying for answers too.

    I wish I knew how to relate with my doctor better.

  8. There is really not a way to relate. Doctors are
    superior people. They don't like to be questioned, or
    persuaded to see a different viewpoint. Period. I have
    seen the syndrome for 20 years, even when they have made blatant mistakes. You have to decide not to believe
    in their competence, and to go only so far as your funds
    or insurance, and your judgment, will carry you. Use them
    as PART of your decision. Don't beat yourself up. Don

  9. Hi Penelope,

    My same exact issue brought me to this page and I was wandering whether you have found the cause and/or solution to your slightly elevated MCH levels? I have tried to investigate this further but always got tired of the system and my doctor's responses so I have given up, but not for good though. When I have the energy, I periodically run another round of tests but always encounter the same issues. I moved to another country and I am thinking of looking into this again in hope someone will help me finally.

    Please let us know what's the status of your situation. Thanks so much and hope you have found answers.

  10. have you ever had your home tested for mold? it took me years to figure out why i had chronic fatigue!docotrs never figured it out until i told them AND found a specialist. one of my symptoms was elevated MCH

  11. If you take a proton pump inhibitor (prilosec, nexium, etc) for extended periods of time it will inhibit your body's absorption of B12 and folic acids although your body will still absorb it through supplemental b12 and folate. Take supplements to get your MCH levels up and increase oxygen being carried from your lungs into your blood stream. ***not medical advice, just neighborly advice***

    1. You are correct. I have been on Prevacid for years because my stomach was in my radiation field when I had radiation treatment for breast cancer. That was considered the problem for a time, but when my symptoms worsened the past 2 years, my oncologist perked up, especially when my iron saturation tanked to below 10% but I had no active bleeding after numerous tests. So hopefully, yes, for some posted here, I hope it is simply an H2 blocker. Good post!

  12. Sounds like b12 deficiency to me. I had completely normal
    'everything'on the indicators front apart from a slightly raised MCH and a low serum b12 that nobody had bothered to read.. Turns out I also had low ferritin (even though my iron was normal) folate. Without the b12 result my GP would have been looking for the cause of symptoms for ever and a day. Trouble is the serum b12 is not accurate as it measures total b12 in bloods. Total includes haptocorrin which is useless and the serum assay doesn't measure b12 at cellular level. What you also need to have done is MMA and Retic count. Neuro symptoms that would indicate these tests are position and vibratory senses being affected - such as shoulder bumps, foot placing etc. All the other tests can be affected by diet or other deficiencies and therefore nothing in macrocytic anemia shows up, normal MCV, RBC - it's all normal. Also I understand that b12 is acute phase reactive so can go into the normal range simply if you are stressed. Get all three tests done and see how you get on?

  13. ^ Yes. I would suggest you look into B12 deficiency.

  14. Doctors are not really good at collaborating with your medical diagnosis. You just have to keep trying. My new physician did not accept that high blood pressure, high blood glucose (should have had diabetes II diag), high chlor, GERD ect., was normal for my age and physical condition. He put me on a gluten, dairy, and legume free diet and the results were amazing. It all went away except I stayed on the high blood pressure diaretic. I lost 9 pounds of water weight in four days. In a couple of months...I started to have brain fog, confusion, poor memory, horse sh** spelling; anxiety, muscle spasms in my neck and shoulders, fatigue, headaches, IBS, and the list goes on. I went back to same doctor who ran a lot of blood tests then passed me off as beign stressed out. Some of those tests were boarderline low or high but apparently not enough to peak his attention. After that I saw an ETN, two gastro specialists, had aGI scope, physical therapist, barioum swallow test, chriopractor, allergist, allergy testing, gyno (hormones), and a psychiatrist. Yea, I was put on Xanax for anxiety. I stopped using the word "anxiety" to describe my symptoms. Every physican went "she is just stressed." Xanax eventually became a daily medication. I suspected a chemical inbalance or issue so I added a water filtration system at home, change all my storage containers to glass, stopped cooking in plastic in microwave, bought mostly organic food, gone Paleo with my diet, use natural soaps and that list goes one. BP still high so went back to original doctor and I taked and taked. I would not let him leave. He finally ordered a lot of blood tests again. I got the somber phone call the next day. Looks like Aldosteronism, low t4, very low WBC, and high DHEA. Did the spit cordisole test yesterday and did not take any Xanax before hand. The aldosterone test wss not ordered before but the cordisole was and I never got a good answer on that result. I may have goofed that one myself because I was in so much neck and shoulder pain, I used up some old muscle relaxers. After not accepting "anxiety" as a diagnosis but as a symptom, I finally got an answer, not a good one, but an answer nonetheless. Adrenal tumors.
    Stick with it if you do not get the answers you need. I learned from a friend of mine who survived two difference cancers because she knew something was wrong and did not stop until a physician actually listened to her.

  15. penelope
    There are 2 possible answer endocrine / MTHFR i have similiar MCH readings mine use to be 36 which is high my b-12 were 400 so doc put me on b-12 injection they got as high as 1600 b-12 blood serum levels but i still had symptoms brain fog and fatigue and lots more long story short i have MTHFR/endocrine problems
    hypothyroid, hypogonadism, adrenal problems cortisol was low side of normal, dhea was low, my doc has worked with me on HRT
    hormone replacement therapy was put on cerefolin nac for MTHFR
    i have both gene mutations which is why i have high homocystein levels which are now improving since taking the methyl b vitamins
    and p5p (b6) more active form i was checked for cancers so far none have been found thank God I am not a doc but hang in there and change doc if you have to i have been thru 20 docs since all this began and the doc i have now has done the most every day i have more hope. Good luck and God bless there are answers just don't give up also remember nutrition is also very important i take over 30 supplements to keep every thing metabolizing properly enyzmes very important.

  16. How strange. I have low RBC & high MCH & no Dr's ever take that seriously. Not that I do either, but (a) I am now pregnant & (b) I was just thinking "if its B12, I'll just up mine so I get back into normal range" (after google diagnosis of course!). Well, guess what? I have 2 copies of MHFR too! My mouth almost dropped to the floor when I read yours & Anon's posts. I am currently 16wks pregnant, but tried so many times & lost 4 babies AND had trouble getting pregs, so that's how we found my MTHFR (but homocysteine ok). Currently on lovenox injections into the stomach, L-5-MTHF, B6 & B12 (Metanx). I have only gotten this far b/c I DEMAND treatment & if 1 Dr doesn't give a sh**, then I go to another, then another, then a naturopath, acupuncturist, etc! Its really truly sad as this takes so much time, $ & effort - just to find that 1 Dr out of 15 that "may care".

    Get MTHFR test & get tested for those vits like the one lady said (10/21/12 Anon) - I am going to go get her tests as I was also told that my B12 & B6 tests just weren't very reliable bc of something-or-other (measures blood not absorption? whatever) so you have to get special tests.

    Good luck!

  17. I've followed this thread and am grateful for all those who have shared information. Could anyone help with a result I was just given which includes: low WBC, High MCV and MCH and low Neutrophils? I've looked each up individually but don't know what they mean when reviewed together.
    Thank you

    1. You need to see a hematologist/oncologist so they can run other tests. How are your platelets? Are they low as well? Is your RBC on the low side as well. Make sure they do not just a simple CBC, but a test called a CBC with differential. That test breaks down all your precursor cells (stem cells) that indicate how many of those will then become full RBC or WBC. Just those low levels you indicated alone are not answer enough. You really need other testing and soon. Don't put it off. Maybe ask if tumor markers should be done as well? Good luck.

  18. Just stumbled onto your blob. I'm not a doctor but have you checked your symptoms against Lyme Disease? You sound exactly like me and I have it. I've got the high MCV and MCH levels. Lyme eat B cells-thus the anemia and a ton of other things. Brain fog, Tinnitus, , stomach pain, joint pain, D deficiency, migraines, fatigue and anemia, fever-flue like symptoms, heat intolerance are pretty classic. Most doctors don't know how to treat Lyme so should you pursue this, look for an LLMD (Lyme Literate Medical Doctor). They are specially trained to recognize this disease through even clinical observations and not relying solely on lab work. It's easy to contact the CDC and ask for LLMD's in your area. Be sure to include your zip code and they will respond very quickly. btw...Lyme is called The Great Mimic because it can look like so many different illnesses and diseases.
    Best Wishes,

  19. I must add to my previous post. I have been tested for every autoimmune disease, endocrine disease, lyme disease, HIV, with every PET, CT, MRI, EDG, Colonoscopy, Capsule EDG, echocardiograms, you name it! I am at the labs for blood work constantly! Every visit, an average of 14 blood tests, 24 urines to the point I am tired of peeing in a collection container! But I am not going to give up. I have been ill with what I now see have been flares, triggered by a medication, or surgery, or some other unknown as of yet event. I even blacked out once already! But I just keep getting worse. The past two weeks I have had angina, but my heart is fine. It is the pain that just keeps getting worse, pain everywhere. Even my eyes. Some days I can hardly see out of them. Earlier in this process I was told the whole anxiety thing, but I knew better being a nurse, so I just force my doctors. If they don't like it, I fire them and move on! I just want everyone on this post to know to always question and find an experienced doctor. One with years and years of practice. Having worked with every level at the University of Chicago, an excellent med school, they were top notch. But now that I live in Florida I am plagued with doctors that have only practiced 2 years and they have gone to med schools that are cutting residencies short in order to push doctors out due to a shortage. So beware! And don't take meds unknowingly unless you know for sure that you really need them! Many doctors love to push drugs, but the side effects and adverse reactions can be dangerous. Question, question, question, and then research, research, research before you accept anything that is done to you. It's your body and your life. Don't willingly hand it off to someone that does not know you! You must get an experienced doctor that you can trust first before accepting any diagnosis.... and fire those that won't accept irregularities on blood tests that could lead you to having a serious disease process down the road! Best wishes to all who are suffering and looking for answers.

    1. Where did you get the Lyme test? You sound like prime canidate of lyme, it causes extreme eye pain as well.. Mine felt like being stabbed with ice picks, I also have it....

      You NEED to get tested through IgeneX and get it done through a LLMD, that is the only way for sure if you will know or not... The CDC standard Western Blot is not a good enough test..

      Recently my blood tests showed low RBC, High MCH, Low MPV, high MONO %, and very low ALKP

      I also supplement with high dose b12 and folate daily, as well as other vitamins and minerals.

    2. Lyme is the first thing that occurred to me, too. I am too familiar on a personal level of your list of symptoms. :{

  20. Its no mystery why u are sick... look up BT in your food, Chemtrails in your air, and Nuclear fallout from japan, all will destroy RBC's and more. Which BTW will keep your HGB, HCT, MCV, and MCH at high levels due to the hemolytic effect.


  21. Hi, I have a low red and white blood cell count, high ba% and, this is weird, a high MCH but a low MCHC. I have brain fog, awful fatigue, horrible chemical sensitivity, constant ringing in ears, my hips hurt a lot ...about to go on disability, thought it was chronic fatigue but now new tests say ANA positive with a 1:640 titer and low C complement, which I am told means autoimmune. I don't have any of the other symptoms of lupus - no rash, etc - and no antibodies to anything else - my doc thinks its shogrens which I don't have symptoms of either. I'm so tired of this. Tried food rotation, paleo, energy work, organ supplements, meditation, glutathione and vit B injections, Methylator support, etc. nothing helps and I keep getting worse. It's not lime disease. Anyone have any thoughts out there? Only symptoms of Shogrens are the light sensitvity in my eyes and fatigue. The low white and red blood cell count has been consistent for the last 4 years. Also I had breast cancer 10 years ago, no chemo or radiation, just lots of surgeries that put a lot of stress on my body. I had my first "flare" of whatever this is right after that. Thyroid is ok. Help please!

  22. Does anyone know what MCHIC stands for? I've been plagued with a scalded, painful face and ears and severe allergies for the past year and have been given prednisone and an anti-malaria prescription for the rest of my life. I appreciate anyone's help with this.

  23. I have the same high much low RBC as many have discussed...I have found temporary relief from the headaches and fatigue by getting a phlebotomy about every 6 weeks. It is old school but I generally feel much better after having it. Just a thought...again its temporary but an amazing relief.