Management of Elevated MCH, MCHC, and MPV
Elevated MCH, MCHC, and MPV values should first be evaluated for potential laboratory interference before proceeding to clinical diagnosis, as false elevations can occur due to factors such as cold agglutination and lipid interference.
Initial Assessment
Rule Out Laboratory Interference
- Check for potential causes of falsely elevated values:
- Cold agglutination (correct by warming sample to 37°C)
- Lipid interference (correct with plasma exchange technique)
- Hemolysis of the sample
- Delayed processing of blood samples
Clinical Correlation
If laboratory interference is ruled out, evaluate for these potential causes:
Elevated MCH and MCHC
- Iron overload conditions:
- Hemochromatosis (genetic or acquired)
- Multiple blood transfusions
- Excessive iron supplementation
- Macrocytic anemias:
- Vitamin B12 deficiency
- Folate deficiency
- Liver disease
- Alcoholism
- Hemolytic conditions:
- Autoimmune hemolytic anemia
- Mechanical hemolysis (artificial heart valves)
- Microangiopathic hemolytic anemia
Elevated MPV
- Platelet activation:
- Cardiovascular disease risk
- Acute coronary syndrome
- Diabetes mellitus
- Inflammatory conditions
- Myeloproliferative disorders
- Essential thrombocythemia
Diagnostic Workup
Basic Laboratory Tests
- Complete blood count with peripheral smear examination
- Reticulocyte count (critical for evaluating bone marrow erythropoietic activity) 1
- Iron studies:
- Serum ferritin
- Transferrin saturation (TSAT)
- Serum iron
- Total iron binding capacity (TIBC)
- Vitamin B12 and folate levels
- Liver function tests
- Renal function tests
Advanced Testing (Based on Initial Results)
- Genetic testing for hemochromatosis (HFE gene mutations) if iron overload is suspected 2
- Hemolysis workup if suggested by peripheral smear:
- Direct Coombs test
- Haptoglobin
- LDH
- Bilirubin (direct and indirect)
- Bone marrow examination if myeloproliferative disorder is suspected
Management Approach
For Hemochromatosis or Iron Overload
- Therapeutic phlebotomy to reduce iron stores 2
- Monitor erythrocyte parameters, as values may decrease but remain elevated even after iron depletion 2
- Screen first-degree relatives for hereditary hemochromatosis if confirmed
For Vitamin Deficiencies
- Vitamin B12 supplementation (1000 μg daily initially, then maintenance)
- Folate supplementation (1-5 mg daily)
- Treat for at least 3 months and until parameters normalize
For Hemolytic Conditions
- Identify and treat underlying cause
- Consider hematology consultation for management of autoimmune hemolytic anemia
- Monitor for complications such as thrombosis
For Elevated MPV with Cardiovascular Risk
- Assess cardiovascular risk factors
- Consider aspirin prophylaxis if indicated
- Manage underlying conditions (diabetes, hypertension)
- High MPV values correlate with increased risk of complications after myocardial infarction and triple vessel coronary artery disease 3
Monitoring and Follow-up
- Repeat CBC and specific parameters (MCH, MCHC, MPV) in 4-8 weeks after initiating treatment
- For iron overload conditions, monitor ferritin levels every 2-3 months during initial treatment phase
- For vitamin deficiencies, check B12 and folate levels after 3 months of supplementation
- In cases of elevated MPV with cardiovascular risk, regular cardiac follow-up is recommended
Special Considerations
- In cancer patients, elevated MCH and MCHC may reflect compensatory bone marrow response to tumor-induced anemia 4
- In pregnant women, interpret values in context of physiologic hemodilution
- In patients with chronic kidney disease, evaluate for EPO deficiency if creatinine ≥2 mg/dL 1
- Consider thrombotic risk in patients with elevated MPV, especially with other risk factors
Common Pitfalls to Avoid
- Failing to rule out laboratory interference before pursuing extensive workup 5
- Overlooking the possibility of hemochromatosis in patients with elevated MCH/MCHC
- Attributing abnormalities solely to one cause without comprehensive evaluation
- Neglecting to evaluate for underlying malignancy in unexplained persistent elevations
- Focusing only on anemia parameters while missing thrombotic risk associated with elevated MPV
By systematically evaluating elevated MCH, MCHC, and MPV values, clinicians can identify important underlying conditions that may impact morbidity and mortality, particularly iron overload disorders and cardiovascular risk factors.