What is Mean corpuscular volume (MCV)?
Mean corpuscular volume (MCV) is the average volume (one can also say average size) of red cells in a specimen. MCV is elevated or decreased in accordance with average red cell size; ie, low MCV indicates microcytic (small average RBC size), normal MCV indicates normocytic (normal average RBC size), and high MCV indicates macrocytic (large average RBC size).
When is the Mean corpuscular volume (MCV) calculated?
Mean corpuscular volume (MCV) is a value calculated during a routine blood test called a complete blood count (CBC). An MCV is routinely performed by an automated machine on all CBCs. It’s included in the portion of the CBC that provides information on your red blood cells in particular, called the RBC (red blood cell) indices.
There are three main types of corpuscles (blood cells) in your blood: red blood cells, white blood cells, and platelets.
An MCV blood test measures the average size of your red blood cells, also known as erythrocytes. Red blood cells move oxygen from your lungs to every cell in your body. Your cells need oxygen to grow, reproduce, and stay healthy.
If your red blood cells are too small or too large, it could be a sign of a blood disorder such as anemia (=a condition in which the body does not have enough healthy red blood cells), a vitamin deficiency, or other medical condition.
MCV is usually not interpreted as an isolated measurement. Rather, it is compared to the results of your other RBC indices and CBC values, like hemoglobin and hematocrit. Your doctor will also consider any symptoms or changes in your health when interpreting these test results.
MCV, along with mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC), is a part of RBC indices (erythrocyte indices), which are measurements and/or calculations for determining the size, content, and hemoglobin concentration.
More recently, red cell distribution width (RDW) has also been included as a part of RBC indices. The indices are useful in the morphologic characterization of anemia. Among these parameters, MCV is the most useful value used to classify the type of anemia based on red cell morphology.
Why is the Mean corpuscular volume (MCV) important to measure?
Your red blood cells carry oxygen throughout your body. This oxygen, in turn, powers your cells. The characteristics of your red blood cells -- including size -- provide information about how successfully they can transport oxygen.
An MCV blood test is helpful because having a large number of atypically large or atypically small red blood cells can indicate certain conditions. It is less helpful if you have a wide variety of red blood cell sizes in a blood sample. In that case, even if there’s an abnormality, the numbers may average out as normal.
What is a normal MCV level?
A typical adult MCV level is 80–100 femtoliters (fl).
- However, typical ranges vary between age groups and sexes.
- MCV results may differ among labs, so people should not worry if their reading is slightly above or below these ranges.
- If you have anemia or other health conditions you can have normal or abnormal MCV results. It is also possible for healthy people to have a normal or abnormal MCV result.
In people with anemia, MCV results are categorized as follows:
- Low MCV means that RBC are smaller than normal and may indicate microcytic anemia. This condition may be caused by iron deficiency, lead poisoning, or thalassemia, a genetic condition that causes your body to have less hemoglobin than normal.
- Normal MCV may indicate normocytic anemia. This can occur when an individual experiences symptoms of anemia due to sudden blood loss, kidney failure, or aplastic anemia, a rare disorder where the body does not produce enough RBC.
- High MCV means that the RBC are too large and indicates macrocytic anemia. This condition can be caused by several factors including low folate or vitamin B12 levels or chemotherapy.
Main types of anemia classified based on red cell morphology and their common causes:
Common causes of microcytic and hypochromic anemia (decreased MCV and MCH) are as follows:
- Iron deficiency anemia
- Anemia of chronic disease
- Thalassemia
- Sideroblastic anemia
Common causes of macrocytic anemia (increased MCV) are as follows:
- Folate deficiency anemia
- Vitamin B12 deficiency anemia
- Liver disease
- Hemolytic anemias
- Hypothyroidism
- Excessive alcohol intake
- Aplastic anemia
- Myelodysplastic syndrome
Common causes of normocytic and normochromic anemia (normal MCV) are as follows:
- Anemia of chronic disease
- Acute blood loss
- Hemolytic anemia, such as autoimmune hemolytic anemia, hereditary spherocytosis, or nonspherocytic congenital hemolytic anemia (G6PD deficiency, other)
- Anemia of renal disease
- Aplastic anemia
Additional notes: when considering the causes of anemia, the guidelines above are helpful but have limitations. For example, hemolytic anemia and aplastic anemia can manifest as normochromic and normocytic anemia or macrocytic anemia; anemia of chronic disease can be normochromic and normocytic anemia or microcytic anemia; sideroblastic anemia can be microcytic anemia, macrocytic anemia, or normochromic and normocytic anemia (due to the presence of dimorphic population of microcytes and macrocytes).
In addition, once the causes of anemia are considered, correlation with clinical findings, including history and physical examination, is important, as is, when necessary, performing more definitive tests to arrive with a definitive diagnosis.
References:
American Society of Hematology [Internet]. Washington D.C.: American Society of Hematology; c2022. Anemia https://www.hematology.org/education/patients/anemia
Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 2nd Ed, Kindle. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Red Cell Indices; 451 p.
Maner BS, Moosavi L. Mean Corpuscular Volume. https://www.ncbi.nlm.nih.gov/books/NBK545275/
National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; How Are Thalessemias Diagnosed? https://www.nhlbi.nih.gov/health/health-topics/topics/thalassemia/diagnosis
National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Iron Deficiency Anemia https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia
Testing.com [Internet]. Seattle (WA): OneCare Media; c2022. Anemia https://www.testing.com/anemia-testing/
Testing.com [Internet]. Seattle (WA): OneCare Media; c2022. Complete Blood Count (CBC) https://labtestsonline.org/understanding/analytes/cbc/tab/test
Testing.com [Internet]. Seattle (WA): OneCare Media; c2022. MCV Test; Available from: https://www.testing.com/tests/mcv-test/
University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2022. Health Encyclopedia: Complete Blood Count with Differential https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=complete_blood_count_w_differential
Yang, J., Yan, B., Yang, L. et al. Macrocytic anemia is associated with the severity of liver impairment in patients with hepatitis B virus-related decompensated cirrhosis: a retrospective cross-sectional study. https://doi.org/10.1186/s12876-018-0893-9
MedlinePlus: National Library of Medicine. Red Blood Cell (RBC) Indices. https://medlineplus.gov/lab-tests/red-blood-cell-rbc-indices/
Merritt BY, Curry CV. Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin Concentration (MCHC) In: Wheeler TM, ed. https://emedicine.medscape.com/article/2054497-overview
National Heart, Lung, and Blood Institute. Blood Tests. https://www.nhlbi.nih.gov/health-topics/blood-tests
Braunstein EM. Evaluation of Anemia. Merck Manual Professional Edition https://www.merckmanuals.com/professional/hematology-and-oncology/approach-to-the-patient-with-anemia/evaluation-of-anemia
Centers for Disease Control and Prevention. Blood and Urine Collection. https://www.cdc.gov/nchs/data/nhanes/nhanes_09_10/labcomp_f.pdf
George TI. Automated Hematology Instrumentation. In: Uhl L, ed. UpToDate. https://www.uptodate.com/contents/automated-hematology-instrumentation
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If someone has a high MCV (Mean Corpuscular Volume) level, it means their red blood cells are larger than usual, a condition called macrocytic anemia. This type of anemia is often associated with certain vitamin deficiencies, medical conditions, or other health factors.
One form of macrocytic anemia, megaloblastic anemia, is commonly caused by deficiencies in cobalamin (vitamin B12) and folate (vitamin B9). These vitamins are essential for DNA synthesis, and a lack of either disrupts normal red blood cell production, resulting in larger, immature cells.
Why MCV Levels May Increase
MCV levels often increase with age. In fact, around 30% of older adults show an elevated MCV without a clear, underlying cause. However, several conditions and factors can lead to a high MCV, including:
- Vitamin B12 deficiency: Often due to poor absorption, especially in older adults or those with gastrointestinal disorders.
- Folate deficiency: This can result from poor dietary intake, certain medications, or increased demand (such as during pregnancy).
- Liver disease: The liver plays a role in red blood cell production, and liver dysfunction can cause changes in red cell size.
- Alcoholism: Alcohol impacts bone marrow function and can lead to larger red cells.
- Hypothyroidism: Low thyroid hormone levels can cause mild macrocytosis.
- Certain hemolytic anemias: In these conditions, red cells are destroyed prematurely, leading to compensatory production of larger red cells.
- Cold agglutinin disease: An autoimmune condition that affects red blood cells.
- Myelodysplastic syndromes (preleukemia): A group of disorders caused by poorly formed or dysfunctional blood cells.
- Aplastic anemia: A rare disorder in which bone marrow fails to produce enough new blood cells.
- Benign familial macrocytosis: Some people have naturally larger red cells without other health issues.
- Chemotherapy drugs: Certain drugs can interfere with DNA synthesis and affect red blood cell production.
- Chronic hypoxia (low blood oxygen levels): Often seen in conditions like COPD.
- Carbon monoxide poisoning: Reduces the oxygen-carrying capacity of blood, leading to compensatory changes in red cell size.
Severe Macrocytosis
The highest MCV levels, generally above 125 (known as severe macrocytosis), are most often associated with vitamin B12 or folate deficiencies or cold agglutinin disease. Severe cases should prompt further investigation, as they may point to underlying conditions requiring medical intervention.
Can High MCV Be Treated?
In cases like vitamin deficiencies, high MCV may be reversible with supplementation and treatment of the underlying condition. For instance, vitamin B12 or folate supplementation can correct anemia caused by deficiencies. However, if the elevated MCV is due to chronic conditions (like liver disease or myelodysplastic syndromes), treatment may focus on managing symptoms rather than reducing MCV itself.
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A low MCV may be seen with:
- Iron deficiency
- Thalassemia (a condition where the body does not make enough normal hemoglobin. It is a genetic condition that a person inherits from their parents. Thalassemia can range from mild to severe. If a person has mild thalassemia, they may have mild anemia or not present with any signs or symptoms. If someone has severe thalassemia, they may require regular red blood cell transfusions.)
- Anemia of chronic disease
- Sideroblastic anemia
- Lead poisoning
- HgC and other hemoglobin hybrids
- Spherocytosis
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The lowest MCV levels (for example, less than 70, called severe microcytosis) are usually a sign of iron deficiency anemia or thalassemia. However, conditions don't always fall neatly into these categories. Iron deficiency anemia may sometimes have a normal MCV.
When a person has an MCV level below 80 fl, this suggests they have microcytic anemia. Microcytic anemia is a type of anemia in which red blood cells are smaller than usual. Iron deficiency causes microcytic anemia. A person usually develops an iron deficiency due to an underlying health condition or factors such as diet and medications.
Iron deficiency causes include:
Blood loss: A person may experience bleeding from the gastrointestinal (GI) tract when they have colon cancer or take nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin. People with heavy periods may also lose a lot of iron through menstrual blood.
Diet: If someone eats a plant-based diet or an omnivorous diet low in iron, they may need to take iron supplements or focus on eating iron-rich foods.
Reduced iron absorption: Ulcerative colitis, Crohn’s disease, weight loss surgery, and Helicobacter pylori infection may all reduce the absorption of iron.
Pregnancy: During pregnancy, people may need to supplement their iron intake, as the body needs more iron to support fetal development.
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Haemoglobin (g/L), Hematocrit (Female range), Hematocrit (HCT) / Packed Cell Volume (PCV), Hemoglobin, Hemoglobin (Female range), Mean Cell Volume, Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC), Mean Corpuscular Volume (MCV), Mean Platelet Volume (MPV), Mean RBC Iron, Mean RBC Iron Concentration, Mean RBC Volume, MXD #, MXD %, Platelet count / Platelets, Platelet Distribution Width (PDW), Platelet-large cell ratio (P-LCR), RBC (Female range), RBC Distribution Width, RDW-CV (Red Cell Distribution Width) in %, RDW-SD (Red Cell Distribution Width) in fL, Red Blood Cells (Erythrocytes / RBC), White blood cells (Leukocytes / WBC)
