How to increase Mean Corpuscular Hemoglobin Concentration (MCHC)?

From the Guidelines

To increase Mean Corpuscular Hemoglobin Concentration (MCHC), treating the underlying cause of low MCHC, typically iron deficiency anemia, is crucial, and the most effective approach is to use intravenous (IV) iron in conjunction with erythropoiesis-stimulating agents (ESAs) as it enhances hemoglobin response, as seen in studies such as Henry et al 1.

When considering ways to increase MCHC, it's essential to understand that MCHC is a measure of the average concentration of hemoglobin in a given volume of red blood cells. Low MCHC values often indicate iron deficiency anemia or other conditions affecting hemoglobin production.

Key steps to improve MCHC include:

• Dietary changes: Consuming iron-rich foods like red meat, spinach, beans, and fortified cereals.
• Oral iron supplementation: Taking ferrous sulfate 325 mg (containing 65 mg elemental iron) once or twice daily between meals with vitamin C to enhance absorption, as suggested by general medical practice and studies on iron deficiency anemia.
• Addressing underlying conditions: Identifying and treating causes of blood loss, such as heavy menstrual periods or gastrointestinal bleeding.
• Ensuring adequate intake of other essential nutrients: Vitamin B12 (2.4 mcg daily) and folate (400 mcg daily) are crucial for red blood cell production.

For patients undergoing chemotherapy, the use of IV iron, such as sodium ferric gluconate complex or iron sucrose, in conjunction with ESAs like epoetin alfa, has been shown to significantly increase hemoglobin levels and enhance the response to ESAs, as demonstrated in studies like Henry et al 1 and Hedenus et al. The choice between oral and IV iron supplementation should be based on the severity of the iron deficiency, the patient's ability to absorb iron, and the presence of any underlying conditions that may affect iron absorption or utilization.

It's also important to note that while iron supplementation is a common approach to increasing MCHC, other conditions such as thalassemia or chronic diseases may require different management strategies. Therefore, if iron supplementation does not lead to an improvement in MCHC, further medical evaluation is necessary to identify and address the underlying cause.

In the context of chronic kidney disease, guidelines suggest that anemia should be treated with ESAs and iron supplementation, adjusting the threshold for anemia based on factors like age, sex, and altitude, as discussed in guidelines such as those from the American Journal of Kidney Diseases 1. However, the primary focus for increasing MCHC remains the correction of iron deficiency and the optimization of erythropoiesis.

From the FDA Drug Label

Although serum ferritin is usually a good guide to body iron stores, the correlation of body iron stores and serum ferritin may not be valid in patients on chronic renal dialysis who are also receiving iron dextran complex Therapy, thus, should aim at not only replenishment of hemoglobin iron but iron stores as well.

To increase Mean Corpuscular Hemoglobin Concentration (MCHC), the focus should be on replenishing iron stores and hemoglobin iron. Key points to consider:

• Iron supplementation: Iron dextran complex can help increase iron stores and hemoglobin levels.
• Monitoring: Regular monitoring of hemoglobin, hematocrit, and serum ferritin levels is essential to assess the response to therapy.
• Dosage calculation: The total dose of iron dextran complex can be calculated based on the patient's weight, desired hemoglobin level, and current hemoglobin level 2.

From the Research

Increasing Mean Corpuscular Hemoglobin Concentration (MCHC)

To increase MCHC, it is essential to address the underlying cause of low MCHC, which is often related to iron deficiency anemia. Here are some ways to increase MCHC:

• Iron supplementation: Iron supplements, such as ferrous sulfate or ferrous gluconate, can help increase MCHC by replenishing iron stores in the body 3, 4, 5, 6.
• Oral iron-replacement therapy: Oral iron-replacement therapy is the mainstay of treatment for iron-deficiency anemia, and it can help increase MCHC 4.
• Parenteral iron preparation: In cases where oral iron supplementation is not effective, parenteral iron preparation, such as iron-dextran, can be used to increase MCHC 3.
• Dietary changes: Increasing dietary iron intake can also help increase MCHC. Foods rich in iron, such as red meat, poultry, fish, and fortified cereals, can help replenish iron stores in the body.
• Ferric citrate: Ferric citrate is an oral medication that can help increase MCHC in patients with iron deficiency and chronic kidney disease (CKD) 7.

Comparison of Iron Supplements

Different iron supplements have varying effects on MCHC:

• Ferrous sulfate vs iron polysaccharide complex: Ferrous sulfate has been shown to be more effective than iron polysaccharide complex in increasing hemoglobin concentration and MCHC in young children with nutritional iron-deficiency anemia 6.
• Ferric citrate vs ferrous sulfate: Ferric citrate has been shown to be more effective than ferrous sulfate in increasing TSAT and ferritin concentrations in patients with moderate to severe CKD and iron deficiency 7.

Important Considerations

It is essential to note that increasing MCHC requires a comprehensive approach that addresses the underlying cause of low MCHC. Iron supplementation should be tailored to the individual's needs, and regular monitoring of MCHC and other hematologic parameters is necessary to ensure effective treatment 3, 4, 5, 6, 7.