What causes low MCV, MCH, MCHC, with high RDW and iron?

Question

Hello doctor,

I would like to help understand my lab results and determine a possible diagnosis. My MCV, MCH, and MCHC are consistently low, while RDW is high. My iron (total serum) is elevated, and although my hemoglobin was previously low at 10 g/dL, it has increased to 11.7 g/dL after starting iron supplements. However, the other abnormal values have persisted.

My MCH and MCHC have always been low, but previous doctors never investigated further. I have a long-standing history of fatigue, lethargy, and depression, and although iron supplements are often prescribed, no one has explored the underlying cause of these abnormal labs.

I would appreciate guidance on what additional blood tests I should consider to better understand what is going on and how to treat it effectively. Please help.

Thank you.

Answer 1

Hi,

Welcome to iclinic.com.

I read your query and can understand your concern.

I have reviewed your lab results in detail (attachments were removed to protect the patient's identity), and yes, you do have anemia, specifically microcytic hypochromic anemia, which means your red blood cells are smaller and paler than normal. This type of anemia (when a person does not have enough healthy red blood cells to carry oxygen in their body) has several possible causes.

Since your TIBC (total iron binding capacity) is high, it suggests iron deficiency anemia. Please note that serum iron levels alone are not always reliable for assessing iron status; TIBC and serum ferritin are better indicators. A high TIBC usually means your body is trying to capture more iron, which often indicates iron stores are low.

Another possibility is that you might have a thalassemia trait, especially since your RBC (red blood cell) count is elevated despite low hemoglobin. To evaluate this, you should get an HPLC test (high-performance liquid chromatography) to check for thalassemia (a genetic condition that causes your body to make less healthy hemoglobin, leading to mild, lifelong anemia) or other hemoglobinopathies (inherited problems with how hemoglobin is made or shaped, which can cause anemia or abnormal red blood cells).

It is also important to find out why you are iron-deficient in the first place:

Are you having heavy periods?
Could there be blood loss through stool?
Do you have issues with iron absorption?
Or is your diet low in iron?

These underlying causes need to be ruled out or addressed. Also, when someone is taking iron supplements, serum iron levels can appear high, which is why TIBC and serum ferritin are better for monitoring iron status.

Additionally, in some cases, people have a condition called iron-refractory iron deficiency anemia (IRIDA), where the body does not respond well to oral iron. These individuals often need IV (intravenous) iron therapy instead.

For now, please continue your iron supplements and maintain an iron-rich diet. In your next update, kindly share your HPLC and serum ferritin reports so we can better understand what is going on. Do not worry; your hemoglobin has already improved, and with the right steps, it can continue to get better.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Please get those lab tests done, and then we can move forward.

I hope it helps.

Please revert in case of further queries.

Thank you.

What causes low MCV, MCH, MCHC, with high RDW and iron?

Decoding Your Anemia Blood Test Results