CHAPTER 11: RED

CELL INDICES
Objectives

At the end of this chapter, the student will be able to:

 Define MCV, MCH and MCHC.
 Explain the purpose of calculating the red cell indices
 Calculate MCV, MCH and MCHC values from given
values
 Define RDW
 Discuss the clinical significance of RDW

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Outline

 Introduction
 MCV
 MCH
 MCHC
 RDW

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11.1. Introduction
 The red cell indices:
 are absolute values calculated from:
 the measured hemoglobin,
 PCV
 RBC count
 are of considerable clinical importance in the diagnosis
and classification of anemias
 are dependent upon the accuracy of the various red cell
parameter estimations

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Introduction cont’d

 The red cell indices include:

 Mean corpuscular volume (MCV)
 Mean corpuscular hemoglobin (MCH)
 Mean corpuscular hemoglobin concentration (MCHC)
 Red cell distribution width (RDW) is another important red
cell parameter obtained by electronic methods
 RDW measures the variation in size of the red blood cells
(degree of anisocytosis)

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 11.2.The Mean Cell Volume (MCV)
 Is the average volume of a red cell expressed in femto
liters (fL)
 Femtoliter is 10-15 of a liter
 MCV is obtained by dividing the PCV by red cell number
 MCV (fl) = PCV (l/l)

No. of RBC/L

Example: PCV = 0.45(l/l)

RBC = 5  1012/l
MCV = 0.45 (l/l) = 90  10-15 = 90fl
5  1012 6
Interpretation
Normal Values
 Men and Women: 80-100 fl
 MCV
 increased in macrocytic anemias
 decreased in microcytic anemia
 iron deficiency anemia
 Thalassemia

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11.3. The Mean Cell Hemoglobin (MCH)

 is the average amount of hemoglobin per individual red

cell expressed in picograms (pg).

 It is given by:
MCH (Pg) = Hb (g/L)
RBC/L
 Example: Hb conc. = 150g/L
RBC = 5  1012/L

MCH (pg) = 150 = 30  10-12 = 30pg

5  1012

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Interpretation

 Normal Value: Men and women: 27-32 pg

 MCH is increased in macrocytic anemia

 MCH is decreased in microcytic anemia
- iron deficiency anemia

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11.4 The Mean Cell Hemoglobin Concentration
(MCHC)

 -Is the average hemoglobin per unit volume of red cells.

MCHC (g/l) = Hb (g/L)

PCV (L/L)

 Example: Hb conc. = 148g/L

PCV = 0.45 (L/L)

MCHC = 148 = 328g/L

0.45
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Interpretation

 Normal Values: Men and women: 32-36 % (320-360

g/L)
 MCHC is increased in some cases of hereditary
spherocytosis
 MCHC is decreased in iron deficiency anemia

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11.5. Red Cell Distribution Width (RDW)

 Another index, the red cell distribution width (RDW), is

specifically designed to reflect the variability of red cell
size.
 It is based on the width of the red blood cell volume
distribution curve
 larger values of RDW indicate greater variability.
 An elevated RDW may be an early sign of iron-
deficiency anemia

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RDW cont’d

 proposed as an aid in distinguishing iron deficiency from

other causes of microcytic anemia, such as thalassemia,
 the RDW is not sufficiently specific to obviate the need
for more specific tests.
 The RDW can be used in the laboratory as a flag to
select those samples submitted for automated blood
count that should have manual review of the blood film
for red cell morphology

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RDW cont’d

 In the Coulter Model S plus, for example, a red cell

histogram is plotted and the RDW(%) is defined as the
coefficient of variation of the MCV:
RDW (%) = SD of MCV x 100
Mean MCV
 The reference range for RDW is from 11% to 15%, but
varies with the instrument used.

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Review Questions

1. Define: MCV, MCH, MCHC, and RDW.

2. What is the purpose of calculating the red cell indices?
3. A complete blood count was performed for a patient and
the following profiles were recorded:
WBC= 8,000/mm3
PCV = 50%
Hb = 15g/dl
RBC count = 5 x 106/mm3
 Calculate the MCV, MCH and MCHC values for the
patient. Interpret your results in the light of the normal
values for these indices.

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