The mean corpuscular hemoglobin concentration (MCHC) may be elevated in a number of situations, some real and some artifact.


Conditions associated with a true increase in MCHC:

(1) hereditary spherocytosis

(2) neonates


Conditions associated with an artifactual increase in MCHC (associated with determination on an automated analyzer):

(1) cold agglutinins

(2) rouleaux

(3) other red cell aggregates

(4) in vivo hemolysis

(5) severe lipemia

(6) elevated heparin concentration


The evaluation of the patient with an elevated MCHC should include:

(1) examination of the specimen tube that was tested (for evidence of hemolysis or lipemia)

(2) examination of the peripheral blood smear

(3) additional testing as needed (cold agglutinins, monoclonal protein, plasma heparin, serum haptoglobin, direct antiglobulin test)


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