Mean corpuscular volume

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The mean corpuscular volume, or "mean cell volume" (MCV), is a measure of the average red blood cell volume that is reported as part of a standard complete blood count. The MCV is calculated by dividing the total volume of packed red blood cells (also known as hematocrit) by the total number of red blood cells. The resulting number is then multiplied by 10. The red blood cells get packed together when they are spun around at high speeds in a centrifuge.

In patients with anemia, it is the MCV measurement that allows classification as either a microcytic anemia (MCV below normal range), normocytic anemia (MCV within normal range) or macrocytic anemia (MCV above normal range). Normocytic anemia is usually deemed so because the bone marrow has not yet responded with a change in cell volume. It occurs occasionally in acute conditions, namely blood loss and hemolysis.

If the MCV was determined by automated equipment, the result can be compared to RBC morphology on a peripheral blood smear. Any deviation would usually be indicative of either faulty equipment or technician error, although there are some conditions that present with high MCV without megaloblastic cells.

For further specification, it can be used to calculate red blood cell distribution width.

Interpretation[edit]

The normal reference range is typically 80-100 fL.[2]

High[edit]

In pernicious anemia (macrocytic), MCV can range up to 150 femtolitres. An elevated MCV is also associated with alcoholism[3] (as are an elevated GGT and a ratio of AST:ALT of 2:1). Vitamin B12 and/or folic acid deficiency has also been associated with macrocytic anemia (high MCV numbers).

Low[edit]

The most common causes of microcytic anemia are iron deficiency (due to inadequate dietary intake, gastrointestinal blood loss, or menstrual blood loss), thalassemia, sideroblastic anemia or chronic disease. In iron deficiency anemia (microcytic anemia), it can be as low as 60 to 70 femtolitres. In some cases of thalassemia, the MCV may be low even though the patient is not iron deficient.

Worked example[edit]

MeasureUnitsConventional unitsConversion
Hct40%
Hb100 grams/liter10 grams/deciliter(deci- is 10-1)
RBC5E+12 cells/liter5E+6 cells/μL(micro is 10-6)
MCV = Hct / RBC8E-14 liters/cell80 femtoliters/cell(femto- is 10-15)
MCH = Hb / RBC2E-11 grams/cell20 picograms/cell(pico- is 10-12)
MCHC = MCH / MCV250 grams/liter25 grams/deciliter(deci is 10-1)

Derivation[edit]

The MCV can be conceptualized as the total volume of a group of cells divided by their number. For a real world sized example, image you had 10 small jellybeans with a combined volume of 10 uL. The mean volume of a jellybean in this group would be 10 uL / 10 jellybeans = 1 uL / jellybean. A similar calculation works for the MCV.

1. You measure the RBC index in cells/uL. Take the reciprocal (1/RBC index) to convert it to uL/cell.

1/5E6 (cells/uL) = 2E-7 (uL/cell).


2. The 1 uL is only made of a proportion of red cells (e.g. 45%) with the rest of the volume composed of plasma. Multiply by the hematocrit to take this into account.

2E-7 (uL/cell) * 0.4 (hematocrit has no units) = 8E-8 uL/cell.


3. Finally convert the units of uL to fL by multiplying by 10^9. The result would look like this.

8E-8 uL/cell* (1E9 fL / 1 uL) = 80 fL/cell


Note: The shortcut proposed above just makes the units work out: 10*40/5=80

References[edit]

  1. ^ Stanley L Schrier, MD Stephen A Landaw, MD, PhD (30 September 2011). "Mean corpuscular volume". uptodate.com. 
  2. ^ MedlinePlus Medical Encyclopedia: RBC indices
  3. ^ Tønnesen H, Hejberg L, Frobenius S, Andersen J (1986). "Erythrocyte mean cell volume--correlation to drinking pattern in heavy alcoholics". Acta Med Scand 219 (5): 515–8. doi:10.1111/j.0954-6820.1986.tb03348.x. PMID 3739755. 

See also[edit]