Normal Hemoglobin and Hematocrit with MCV 98 and MCH 33.8: Does This Mean Anemia?
No, normal hemoglobin and hematocrit values by definition exclude anemia, regardless of MCV or MCH values. Anemia is specifically defined by low hemoglobin or hematocrit levels, not by red cell indices alone 1.
Understanding the Definition of Anemia
Anemia requires hemoglobin below 13 g/dL in men or below 12 g/dL in non-pregnant women according to WHO criteria, and if your patient's hemoglobin and hematocrit are within the normal reference range for your laboratory, anemia is not present 1.
The normal ranges for adult males and post-menopausal females are hemoglobin 15.5 ± 2.0 g/dL and hematocrit 47 ± 6%, while menstruating females have hemoglobin 14.0 ± 2.0 g/dL and hematocrit 41 ± 5% 1.
Interpreting the Red Cell Indices
An MCV of 98 fL falls within the normal range (80-100 fL) and indicates normocytic red blood cells, which is the typical finding in healthy individuals 1.
An MCH of 33.8 pg is at the upper end of normal (26-34 pg) but does not indicate pathology when hemoglobin and hematocrit are normal 2, 3.
The anemia of chronic kidney disease is characteristically normocytic and normochromic, meaning normal MCV and MCH values do not exclude underlying pathology but cannot define anemia in the absence of low hemoglobin 1.
Clinical Context and Common Pitfalls
Hemoglobin is the preferred parameter for defining anemia because it remains stable during sample storage, whereas hematocrit can falsely increase by 2-4% with prolonged storage or in the presence of hyperglycemia 1, 4.
Red cell indices (MCV, MCH, MCHC) are useful for classifying the type of anemia once it is established by low hemoglobin, but they cannot diagnose anemia when hemoglobin is normal 1.
Microcytosis (low MCV) may reflect iron deficiency or hemoglobinopathies, while macrocytosis (high MCV) may suggest vitamin B12 or folate deficiency, but these interpretations are only clinically relevant when anemia is actually present 1.
What These Values Actually Indicate
Normal hemoglobin with an MCV at 98 fL and MCH at 33.8 pg simply indicates that red blood cells are of normal size and contain a normal amount of hemoglobin 5.
If there were concern for evolving iron deficiency, you would expect to see a low MCV (typically <80 fL) and low MCH, not values in the normal-to-high range 1.
Slightly elevated MCH values (32-34 pg) can be seen in normal individuals and may reflect well-hemoglobinized red cells, particularly in the absence of any other abnormalities 3.