BloodTestEasy

MCH 38.1 pg

Very high

Consider discussing this with your doctor in the coming weeks.

15222633374038.1
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Your band
Very high · 37–40 pg
Distance from typical range
5.1 pg above 33.0

What 38.1 pg means

An MCH of 38.1 pg is far above the normal range and usually means either markedly oversized red cells or a lab artifact affecting the measurement. Either way, it should be sorted out with your clinician soon.

Genuine values this high most often come from advanced vitamin B12 or folate deficiency, where red cells become very large and anemia is usually present too. Just as often, though, a result in this territory is a measurement artifact: cold agglutinins (antibodies that clump red cells in the tube), very high blood fats, or a very high white cell count can all falsely inflate MCH. The first step is usually to confirm the number — a repeat draw and a blood smear — and then treat whatever real cause emerges. Untreated severe B12 deficiency can cause lasting nerve damage, which is why this shouldn't sit for months.

Most US laboratories consider roughly 27 to 33 pg per cell normal for adults of any sex, following the convention used by MedlinePlus and major US health systems.

Common causes

  • Severe vitamin B12 deficiency, including pernicious anemia
  • Severe folate deficiency
  • Cold agglutinin disease causing red cells to clump in the sample (falsely raises MCH)
  • Very high triglycerides or a markedly elevated white cell count interfering with the measurement
  • Myelodysplastic syndrome or other bone marrow disorders
  • Heavy alcohol use combined with liver disease
  • Chemotherapy or immunosuppressant drugs (e.g., hydroxyurea, azathioprine)

Symptoms that can go with it

  • Significant fatigue and weakness
  • Shortness of breath on exertion
  • Numbness, tingling, or burning in hands and feet
  • Unsteady walking or balance problems
  • Memory changes, confusion, or low mood
  • Sore red tongue and mouth ulcers
  • Pale or yellow-tinged skin

Sensible next steps

  1. Contact your clinician within the next few days to confirm the result and start a workup — a repeat CBC with a blood smear is often the first move
  2. Expect B12, folate, thyroid, and liver testing; ask about a reticulocyte count as well
  3. Report nerve symptoms (numbness, tingling, balance trouble, confusion) immediately, since these push treatment faster
  4. Bring a complete list of medications, supplements, and your typical alcohol intake
  5. If B12 deficiency is confirmed, follow through on the full treatment course and re-testing your clinician recommends — nerve recovery depends on early, sustained treatment

Frequently asked questions

Is 38.1 pg a normal MCH level?

No — 38.1 pg is far above the typical 27–33 pg range. This level suggests either advanced B12/folate deficiency or a lab artifact (such as cold agglutinins), and it should be confirmed and investigated with your clinician soon.

What does a low MCH mean?

A low MCH means each of your red blood cells is carrying less hemoglobin than normal — the cells are small and pale. The two most common reasons are iron deficiency and thalassemia trait, and iron studies (especially ferritin) usually tell them apart. Your hemoglobin on the same report shows whether the low MCH comes with actual anemia.

What does a high MCH mean?

At 38.1 pg, there are two main possibilities: advanced B12 or folate deficiency, or a measurement artifact such as cold agglutinins falsely inflating the number. Your clinician will usually confirm with a repeat test and blood smear before treating.

What is the difference between MCH and MCHC?

MCH is the average amount of hemoglobin in each red blood cell (measured in picograms). MCHC is the average concentration of hemoglobin — how densely packed it is relative to the cell's size (measured in g/dL). A large cell can have a high MCH but a normal MCHC, because the extra hemoglobin is spread through a bigger cell. Labs report both because together with MCV they help pinpoint the type of anemia.

Can my MCH be abnormal even if my hemoglobin is normal?

Yes, and it's common. MCH describes the average hemoglobin per cell, not your total. Early iron deficiency and thalassemia trait can both lower MCH while total hemoglobin is still normal, and mild B12 shortfall or alcohol use can raise it the same way. An abnormal MCH with normal hemoglobin is often an early clue worth a routine check rather than a sign of established anemia.

How do I fix an abnormal MCH of 38.1 pg?

You treat the cause, not the number. MCH corrects on its own over two to three months once the underlying issue — iron deficiency, B12 or folate deficiency, alcohol, thyroid disease, or a medication effect — is addressed, because red cells live about 120 days and the abnormal ones must be replaced by new ones. Get the cause identified with your clinician before starting any supplement.

Check a different MCH value

Related values on your lab report

Sources

Educational information, not medical advice. Reference ranges vary between labs — always compare with the range printed on your own report and discuss results with your doctor. Full disclaimer