Hemoglobin is responsible for the red color in blood and for circulating oxygen around the body. The lack of oxygen caused by a low hemoglobin concentration may cause fatigue and other anaemia symptoms.

The mean corpuscular hemoglobin concentration (MCHC) test is a standard part of the complete blood count (CBC) that is done during blood analysis, and the MCHC value is used to evaluate the severity and cause of anemia.

Causes of low MCHC

Anemia is characterized by a low level of hemoglobin. This may be caused by normal conditions, such as pregnancy, or by having an iron-deficient diet. In rare cases, it may be caused by life-threatening illnesses, including cancer.

Factors that cause low levels of hemoglobin include:

• fewer blood cells being produced
• red blood cells being destroyed faster than they can be produced
• blood loss

Causes of blood loss include wounds, ulcers, hemorrhoids, or cancers. It can also be caused by regular events, such as frequent blood donation and menstruation.

The following types of anemia are associated with a low hemoglobin concentration:

Iron deficiency anemia

This condition can be caused by an iron-deficient diet or by an inability to absorb iron. When less iron is available for red blood cell development, the red blood cells become smaller and paler.

Pernicious anemia

This can be caused by a diet that is deficient in vitamin B-12. The condition also affects people who cannot absorb vitamin B-12.

Aplastic anemia

This condition is characterized by a reduced number of red blood cells, white blood cells, and platelets.

Hemolytic anemia

This happens when red blood cells are removed from the body before the end of their lifespan and are not replaced quickly enough by the bone marrow.

Other conditions linked with MCHC

In rare cases, anemia may point to other more serious conditions, including:

• cancer or leukemia treatments
• bone marrow defects
• gastrointestinal tumors
• kidney and liver disease
• inflammatory disorders

Kidney disease may cause anemia because the kidneys are not able to produce enough erythropoietin. This is a hormone that signals the bone marrow to make red blood cells.

Chemotherapy for cancer treatment may also affect the production of new red blood cells, resulting in anemia.

The following medical conditions can destroy red blood cells faster than they can be made:

• enlarged spleen
• porphyria
• urinary tract infection
• thalassemia
• vasculitis
• hemolysis

Symptoms

A slightly low hemoglobin concentration does not always produce noticeable symptoms and may not always be a sign of illness. Some people are unaware that they have low hemoglobin until they have a routine blood screening.

Other people may develop noticeable symptoms, including:

• weakness and fatigue
• shortness of breath
• pale skin and gums
• fast or irregular heartbeat
• cold hands or feet
• dizziness or headache
• lack of concentration
• chest pain

These symptoms will alert a doctor to the possibility of anemia.

Diagnosis

There are many underlying causes of anemia. The first step in developing a treatment plan is to establish what type of anemia is present and to assess its severity. A MCHC test will help point a doctor in the right direction.

Anemia is diagnosed when the hemoglobin value is less than 13.5 grams per deciliter (g/dL) in men or less than 12.0 g/dL in women. In children, normal hemoglobin values vary with age.

A doctor may also check the following values:

• vitamin B-12 and folate
• ferritin and iron saturation

Folate and vitamin B-12 help the body produce red blood cells. Ferritin is an iron-containing blood protein, while iron saturation is the amount of iron that is available to use.

If internal bleeding is a factor, then a person may require an endoscopy or an X-ray. During an endoscopy, a camera is used to detect possible causes of bleeding in the upper gastrointestinal tract.

Treatment

Treatment for anemia may include dietary changes, supplements, medication, or blood transfusions. Some of these treatments may be carried out in a hospital.

Severe iron-deficiency anemia may require iron injections, intravenous iron therapy, or a blood transfusion. The aim is to restore red blood cells, hemoglobin, and iron levels.

On average, adult men need 8.7 milligrams (mg), and adult women need 14.8 mg of iron per day. After menopause, women can reduce their iron intake to 8.7 mg per day.

A synthetic form of the human erythropoietin protein can sometimes be used instead of a blood transfusion. This medication stimulates the bone marrow to make more red blood cells and to increase hemoglobin.

While this treatment has been approved by the FDA for some applications, such as anemia caused by chemotherapy, it has not been approved for all types of anemia. It is still prescribed if necessary to avoid blood transfusions.

Prevention

Some types of anemia can be prevented by following a diet that has enough iron, vitamin B-12, folate, and vitamin C to produce healthy blood cells.

Red meat, poultry, and seafood are all good sources of iron. Vegetarians and vegans may need to increase iron intake with beans, lentils, tofu, and peas.

Iron-fortified food products can also be helpful. These include cereals, soya and nut milks, and some orange juice brands.