CHAPTER 11: RED CELL

INDICES
 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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 Red cell indices
• The red cell indices include
– Mean corpuscular volume (MCV)MCV
– Mean corpuscular hemoglobin (MCH)MCH
– Mean corpuscular hemoglobin concentration (MCHC)
MCHC
• Red cell distribution width (RDW)
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)
• It must be remembered that the red cell count has the greatest
potential error and must be performed with extreme care
preferably using an electronic counter.

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 The Mean Cell Volume (MCV)

• Is the average volume of a red cell expressed in femto litres

(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:
Example PCV = 0.45(l/l)
RBC = 5  1012/l
MCV = 0.45 (l/l) = 90  10-15 = 90fl
5  1012

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 Interpretation

Normal Values
– Men and Women: 76-100 fl
• MCV
– increased in
• macrocytic anemias
– decreased in
• iron deficiency anemia
• Thalassemia
• microcytic anemia

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 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:
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:
Value Men and women: 27-33 pg

• MCH is increased in
– macrocytic anemia
• MCH is
i decreased in - microcytic anemia
- iron deficiency anemia

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 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:
Values Men and women: 33-37 g/dl (330-370 g/L)
• MCHC is increased in some cases of hereditary spherocytosis

• MCHC is decreased in iron deficiency anemia

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 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 11.5% to 14.5%, 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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