Mean corpuscular hemoglobin

concentration
The mean corpuscular hemoglobin concentration, or MCHC, is a
measure of the concentration of hemoglobin in a given volume of
packed red blood cells. It is reported as part of a standard complete
blood count.
It is calculated by dividing the hemoglobin by the hematocrit.
Reference ranges for blood tests are 32 to 36 g/dl,[1] or between 4.9
[2]
to 5.5[2] mmol/L. It is thus a mass or molar concentration. Still,
many instances[3][4] measure MCHC in percentage (%), as if it was a
mass fraction (mHb / mRBC). Numerically, however, the MCHC in
g/dl and the mass fraction of hemoglobin in red blood cells in % are
identical, assuming a RBC density of 1g/mL and negligible
hemoglobin in plasma.

Interpretation

MCHC is diminished ("hypochromic") in microcytic anemias, and

normal ("normochromic") in macrocytic anemias (due to larger cell
size, though the hemoglobin amount or MCH is high, the
concentration remains normal). MCHC is elevated ("hyperchromic")
in hereditary spherocytosis, sickle cell disease and homozygous
hemoglobin C disease.[5]
This count is used to give a rough guide to what shade of red, RBC
will be. (paler=lower than the standard)

Complications with cold agglutinin

Because of the way automated analysers count blood cells, a very

high MCHC (greater than about 370 g/L) may indicate the blood is
from someone with a cold agglutinin. This means that when their
blood gets colder than 37°C it starts to clump together. As a result,
the analyzer may incorrectly report a low number of very dense red
blood cells for blood samples in which agglutination has occurred.
This problem is usually picked up by the laboratory before the result
is reported. The blood is warmed until the cells separate from each
other, and quickly put through the machine while still warm.This is
the most sensitive test for iron deficiency anemia.