MCH and thalassaemia: what a low level can mean
Haemoglobin is a protein in the red blood cells that carries oxygen, and according to the NVKC that protein is abnormal in thalassaemia. According to the NVKC, the MCH value gives the amount of haemoglobin in the red blood cells, calculated from the haemoglobin and the number of red blood cells.
According to the NVKC, in thalassaemia the MCH is too low, and a low MCH can also point to anaemia from iron deficiency. According to the NVKC, a lack of vitamin B12 and/or folate can come with anaemia and a high MCH. Only a blood test makes the MCH value visible.
The NVKC gives about 1.70 to 2.10 femtomol for healthy adults, and Certe uses 1700 to 2100 amol for adults older than 18.
Doctor's Assessment Included
MCH is the average amount of haemoglobin, the protein that carries oxygen, in one red blood cell; it is calculated from haemoglobin and the red cell count. Certe uses 1700 to 2100 attomol for adults, equal to 1.70 to 2.10 femtomol.
- A low MCH can fit iron deficiency or thalassaemia, a defect of the haemoglobin protein; a high MCH a lack of vitamin B12 or folate.
- Star-SHL, Unilabs and Diagnostiek voor U publish no limit for MCH.
Reference Ranges
See the value that applies to you:
Choose male or female — this range differs by sex.
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This range also depends on context such as cycle phase or sample material; the highlighted rows apply to your group.
Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.
MCH (Mean Corpuscular Hemoglobin): what Dutch laboratories use
| Laboratory | Group | Reference value (amol) | Relative scale |
|---|---|---|---|
| Certe | · Male · 18 years and older | 1700–2100 amol |
1700 2100
|
| Certe | · Female · 18 years and older | 1700–2100 amol |
1700 2100
|
Source: Certe
Each value as the laboratory itself publishes it, retrieved in 2026.
MCH (Mean Corpuscular Hemoglobin): what this test measures
Diagnostiek voor U reports MCH, according to the NVKC the amount of haemoglobin in the red blood cells, in femtomol (fmol), and names an ADVIA 2120 or ADVIA560 analyser for this determination.
MCH (Mean Corpuscular Hemoglobin): why this value matters
According to the NVKC, an MCH value helps find blood disorders involving abnormal red blood cells. Thuisarts names sickle cell disease and thalassaemia as blood disorders that can cause anaemia.
MCH (Mean Corpuscular Hemoglobin): how the blood test works
- Referral
- No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
- The draw
- A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
- Where
- 650+ draw sites run by independent laboratories across the Netherlands. Draw sites
MCH (Mean Corpuscular Hemoglobin): when is testing worthwhile?
When looking for a blood disorder with abnormal red blood cells, an MCH test is one of the tests a doctor can request according to the NVKC; usually the MCH test is part of the complete blood count.
MCH (Mean Corpuscular Hemoglobin): symptoms of a high or low value
Low Levels
According to the NVKC, an MCH that comes out too low may fit anaemia from iron deficiency. According to Thuisarts, anaemia can also be temporary after an infection such as an ear infection or stomach flu, especially in children.
High Levels
According to the NVKC, an MCH that comes out too high may fit anaemia from a lack of vitamin B12 and/or folate. According to the NVKC, the MCH value can also be abnormal with abnormal red blood cells, as in a blood disorder.
MCH (Mean Corpuscular Hemoglobin): causes of a low or high value
What lowers the value
-
Iron deficiency
A low MCH can point to anaemia from iron deficiency.
-
Thalassaemia
In thalassaemia, a defect of the haemoglobin protein in the red blood cells, MCH is too low.
What raises the value
-
Vitamin B12 or folate deficiency
A high MCH can point to anaemia from a lack of vitamin B12 or folate.
-
Fat or burst cells in the blood sample
A lot of fat in the blood sample gives a falsely high MCH, and red blood cells that burst in the tube can do the same.
MCH (Mean Corpuscular Hemoglobin): lifestyle and this value
An abnormal MCH value is one to put to the GP; according to Thuisarts, more tests are sometimes needed to find the cause of anaemia.
MCH (Mean Corpuscular Hemoglobin): frequently asked questions
What is thalassaemia?
According to the NVKC, thalassaemia is an abnormality of the haemoglobin protein in the red blood cells, and in thalassaemia the MCH is too low. Thuisarts names thalassaemia as one of the blood disorders that can cause anaemia.
Why can MCH come out higher in sickle cell disease?
According to Gulati and colleagues (Annals of Laboratory Medicine, 2022), red blood cells may break down inside the body in sickle cell disease, and then the blood count gives a higher than normal MCH, because the haemoglobin outside the cells is counted too.
Can a long-lasting disease cause anaemia?
Yes, according to Thuisarts a long-lasting disease such as rheumatism, a kidney disease, a liver disease or cancer can cause anaemia, as can treatment with chemotherapy, and for that anaemia an MCH value helps trace the cause, according to the NVKC.
MCH (Mean Corpuscular Hemoglobin): sources
- Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
- NVKC, Alles over testen: MCH, allesovertesten.nl, geraadpleegd 2026-10-06 (retrieved 2026) allesovertesten.nl
- Gulati G, Uppal G, Gong J. Unreliable Automated Complete Blood Count Results: Causes, Recognition, and Resolution. Ann Lab Med 2022;42(5):515-530. (retrieved 2026) pmc.ncbi.nlm.nih.gov
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