Low MCHC symptoms and who’s at risk

In this article:

• What does low MCHC feel like?
• Early signs
• Other symptoms
• Low MCHC symptoms and demographics
• High vs. low MCHC symptoms
• When to see a doctor
• Complications
• Can low MCHC be cured?
• Living with low MCHC

In this article

• What does low MCHC feel like?
• Early signs
• Other symptoms
• Low MCHC symptoms and demographics
• High vs. low MCHC symptoms
• When to see a doctor
• Complications
• Can low MCHC be cured?
• Living with low MCHC

Mean corpuscular hemoglobin concentration, or MCHC, indicates the average hemoglobin concentration in blood. Hemoglobin is the protein in red blood cells that carries oxygen throughout the body to various tissues. For someone undergoing blood work for MCHC, they are most likely being evaluated for a condition known as anemia. 

Anemia is a condition in which the hemoglobin in the blood does not carry sufficient oxygen throughout the body’s tissues. Because hemoglobin is an iron-rich molecule, the most common cause of iron-deficiency anemia is not having enough iron. Deficiency anemia can have various causes, but the most common are losing too much blood, not making enough healthy red blood cells, or breaking down red blood cells faster than the body can replace them.

The blood level cutoff for low MCHC is any result below 32 g/dL, although this can vary by lab. 

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What does low MCHC feel like?

Low MCHC includes feeling generally fatigued, weak, and unwell. Someone with low MCHC may also experience dizziness, rapid heartbeat, and shortness of breath. Skin may sometimes appear paler than normal.

Keep in mind that a low MCHC is not a disease, but rather a lab finding. It often needs to be interpreted alongside other lab values like mean corpuscular volume (MCV) and ferritin.

What are the early signs of low MCHC?

Symptoms of low MCHC can be subtle at first. Signs of low MCHC can often overlap with other medical conditions, making it hard to pinpoint the exact cause. That’s why it’s best to consult a medical professional if you experience any of the symptoms below and they are affecting your overall health. Healthcare providers may do a physical exam and recommend blood tests to determine the underlying cause. 

Some early signs of low MCHC may be attributed to iron deficiency anemia and include:

• Fatigue
• Tiredness
• Dizziness
• Lightheadedness
• Cold extremities (hands and/or feet)
• Headache

While these are the beginning signs of low MCHC, anemia can progress into more severe symptoms. Worsening signs of low MCHC include:

• Pale skin
• Brittle, easily breakable nails
• Shortness of breath or difficulty breathing at rest or with minimal activity
• Sore or inflamed tongue
• Mouth sores

Other low MCHC symptoms

Severe symptoms such as difficulty breathing and an irregular heartbeat are rare but could occur as the disease progresses. However, there may be an underlying health condition that can lead to the development of low MCHC. 

Low MCHC levels are often linked to different types of anemia, including:

• Iron deficiency anemia
• Pernicious anemia
• Aplastic anemia
• Hemolytic anemia

Other conditions that can lead to low MCHC include:

• Heavier or longer periods than normal
• Pregnancy
• Chronic blood loss from certain digestive conditions, like ulcers or polyps
• Thalassemia or other genetic blood disorders
• Certain cancers that can cause bleeding 
• Bleeding disorders

If you are experiencing any of the symptoms above or have a condition listed above, speak with your healthcare provider if you are concerned about your MCHC blood test results.

Low MCHC symptoms and demographics

While a low MCHC can affect anyone, certain trends are evident in demographic data. Studies show that gender and race may influence the prevalence of anemia and low MCHC levels.

The Office of Disease Prevention and Health Promotion states that women are more likely than men to have iron deficiency. This is due to women losing blood during menstruation, in addition to pregnancy and childbirth, sometimes leading to iron deficiency. In high-income countries like the United States, around 13% of women of childbearing age have iron deficiency anemia. 

Recent U.S. survey data also shows racial and ethnic differences in anemia risks. NHANES analyses through 2020, and newer CDC reports from 2021–2023, find that non-Hispanic Black adults consistently have higher rates of anemia than non-Hispanic White adults, while Hispanic and Asian women also show increased anemia prevalence. Older adults, across all groups, are the most likely to have anemia.

Low MCHC presents similarly across various demographics, with fatigue, tiredness, and weakness being the most common and recognizable symptoms, although the onset and cause of anemia vary.

High vs. low MCHC symptoms

The normal range of MCHC is 32 g/dL to 36 g/dL and is measured as part of a complete blood count (CBC test). Low MCHC (hypochromia) indicates that red blood cells have lower levels of hemoglobin, which can impair the delivery of oxygen to tissues. Common causes include iron deficiency, thalassemia syndromes, lead poisoning, sideroblastic anemia, and, less often, anemia of chronic disease.

Rare genetic conditions can also cause low MCHC, including forms of hypochromic microcytic anemia with iron overload. In this condition, the normal transport of iron in cells is impaired as the red blood cells cannot access iron within the blood. This results in a decrease in red blood cell production, leading to the formation of abnormal red blood cells that are small and pale.

High MCHC levels are less common and refer to a higher-than-normal amount of hemoglobin in red blood cells. Potential causes include autoimmune hemolytic anemia, hereditary spherocytosis, severe burns, and certain thyroid or liver disorders. Some hemoglobin variants, such as those in sickle cell disease or hemoglobin C disease, can also increase MCHC levels.

The tricky part is that some low and high MCHC symptoms overlap, making it hard to differentiate and determine which you are experiencing. Fatigue, weakness, and paleness may indicate either high or low MCHC, although underlying health issues can cause different symptoms.

Comparing high vs. low MCHC
	High MCHC	Low MCHC
Test results	Above 36 g/dL	Below 32 g/dL
Shared symptoms	fatigue weakness paleness
Unique symptoms	yellowing of the skin and/or whites of the eyes due to hemolysis chest pain fever fainting enlarged spleen	dizziness shortness of breath dry skin brittle nails rapid heartbeat

When to see a doctor for low MCHC symptoms

It’s important to see a trusted healthcare professional if symptoms of low MCHC appear. The earlier it is caught, the sooner actions can be taken to prevent worsening. Your medical team is well-equipped to make informed decisions regarding your treatment plan.

Contact a healthcare provider if you seem more fatigued, tired, and weaker than normal. Your provider may order a blood sample to check your MCHC levels and identify whether anemia or another condition is causing the symptoms.

If you are experiencing more severe symptoms, such as difficulty breathing, discoloration of the skin or the whites of the eyes, shortness of breath, a sore, inflamed, or swollen tongue, or mouth ulcers, you should visit your local emergency room. These signs may indicate more serious complications like cancer, kidney disease, or liver disease. 

Since heavy or prolonged menstrual bleeding is a common cause of iron deficiency and low MCHC, consider scheduling a visit with a gynecologist if you notice changes in your menstrual cycle.

Complications of low MCHC

Untreated low MCHC levels may cause extra stress on the heart, cognitive changes, a weakened immune system, and a decreased ability to exercise. It can also lead to problems during pregnancy or allow the underlying cause to worsen. 

A more severe complication of low MCHC levels is anemic hypoxia. Anemic hypoxia happens when blood cannot carry enough oxygen to the tissues throughout the body. This causes a buildup of carbon dioxide and can lead to life-threatening complications if not treated promptly and properly.

Symptoms of anemic hypoxia may include:

• Fast breathing
• Dizziness or lightheadedness
• Rapid heartbeat
• Confusion or trouble concentrating
• Pale, cold, or clammy skin
• Chest discomfort
• Irritability or other mental changes

Seek immediate medical attention if you experience these symptoms, as they indicate a medical emergency.

Can low MCHC be cured?

In most cases, treating the underlying cause can help improve MCHC levels. This could mean replenishing iron levels or treating the condition affecting red blood cell counts. A low MCHC doesn’t always require medication.

• Diet. Eating more iron-rich foods such as spinach, red meat, broccoli, chickpeas, and fish can help increase iron stores. Foods high in vitamin B6, such as poultry, fish, bananas, and fortified cereals, as well as fiber-rich foods like vegetables, fruits, and whole grains, may support better iron absorption.
• Medications or supplements. Many people with low MCHC caused by iron deficiency need iron supplements. These are usually taken as tablets but can also be given through an infusion if levels are very low or if tablets are not well tolerated. Vitamin B12 and folate supplements are also available for those who may be deficient. Vitamin C may also be recommended to help boost iron absorption. 
• Exercise. Regular activity, such as walking, light strength training, or low-impact cardio, may improve energy levels and reduce fatigue once treatment has started.
• Procedures. Blood transfusion from blood donors may also be a viable option for severe anemia that causes symptoms or affects oxygen levels. Bone marrow transplants can replace faulty blood-forming cells with healthy ones, but are typically reserved for rare genetic or bone marrow disorders.

The bottom line? There are options. A diagnosis of anemia may seem intimidating at first, but there are many options and opportunities to manage it effectively. A healthcare provider can provide helpful information and discuss the best treatment plan for signs of anemia.

Living with low MCHC

While a low MCHC can seem complicated, it is essential to understand that it is treatable. Taking iron supplements and following a balanced diet can help manage MCHC levels.

If your healthcare provider prescribes a medication, be sure to continue taking it for as long as instructed. Do not stop taking the medication or receiving treatment without seeking medical advice.

It is important to take control of your health and stay active while receiving treatment. This is beneficial for all ages, including older adults. Walking or engaging in other mild exercises, such as swimming, can help keep the body moving and boost overall blood health. 

Once MCHC levels improve, symptoms typically improve. Most people see improved energy levels and reduced tiredness or weakness. Skin pigment should return to normal if it has changed, and breathing should also return to its normal state.