Mean corpuscular volume (MCV)
MCV is the average size of red blood cells. US survey ranges for adults run from 75 to 80 fL up to 98 to 103 fL, by sex and age. Low values go with iron deficiency and thalassemia trait. High values go with vitamin B12 deficiency, alcohol and liver disease, and were linked to more deaths in two cohorts.
- Status
- Part of the complete blood count, ordered by a clinician and also sold direct to consumers by some US laboratories. FDA classifies automated cell counters, which may calculate or measure the red cell indices including mean corpuscular volume, as class II devices [1].
- Measures
- The average volume of a person's red blood cells, in femtoliters, measured directly by an electronic counter or calculated from the hematocrit and the red cell count [2].
- Also called
- MCV, mean corpuscular volume, mean cell volume, mean red cell volume, erythrocyte mean corpuscular volume, MCV CBC, red cell size
- Tested for
- anemia workup, iron deficiency, vitamin B12 deficiency, folate deficiency, thalassemia trait, alcohol use, fatigue, general checkup
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Linked in research4
- ModerateLinked to more deaths at higher MCV in two East Asian cohorts, including a 44% to 55% higher death rate in the top quarter of non-anemic Korean adults.
- LimitedLimited evidence: in one US survey analysis, MCV told iron-deficient from iron-replete women and children moderately well, and less well than hemoglobin in women.
- LimitedLimited evidence: in one Thai study of pregnant women, an MCV of 80 fL or below picked up 93% of thalassemia trait carriers.
- LimitedLimited evidence: in one hospital series of 300 adults with an MCV of 100 fL or above, drug therapy, alcohol and liver disease were the most common explanations.
Reported risks0
No risks sourced yet.
Reference ranges
Each range is the one its source published, in fL. Where sources differ, each is shown.
US national survey laboratory procedure manual, 2017 to 2018, men aged 19 to 65
Men aged 19 to 65, as the reference range used by the survey laboratory · [3]
| Range | What the source calls it |
|---|---|
| below 79.8 fL | No name given |
| 79.8 to 99.1 fL | "reference range" |
| above 99.1 fL | No name given |
The 2.5th to 97.5th percentiles of everyone measured in the US national survey from 1999 to 2004, calculated by ranking, without screening out people with iron deficiency or illness [3].
US national survey laboratory procedure manual, 2017 to 2018, men aged 66 and older
Men aged 66 and older, as the reference range used by the survey laboratory · [3]
| Range | What the source calls it |
|---|---|
| below 81.4 fL | No name given |
| 81.4 to 102.7 fL | "reference range" |
| above 102.7 fL | No name given |
Derived the same way from the 1999 to 2004 survey sample [3]. A study of 8,089 people on one type of analyzer found that MCV rose with age across the whole age range, by a mean of 6.6% from the youngest to the oldest age class [4].
US national survey laboratory procedure manual, 2017 to 2018, women aged 19 to 65
Women aged 19 to 65, as the reference range used by the survey laboratory · [3]
| Range | What the source calls it |
|---|---|
| below 74.6 fL | No name given |
| 74.6 to 98.2 fL | "reference range" |
| above 98.2 fL | No name given |
Derived the same way from the 1999 to 2004 survey sample, which was not screened for iron deficiency. The lower limit is about 5 fL under the limit for men of the same age [3].
US national survey laboratory procedure manual, 2017 to 2018, women aged 66 and older
Women aged 66 and older, as the reference range used by the survey laboratory · [3]
| Range | What the source calls it |
|---|---|
| below 80.3 fL | No name given |
| 80.3 to 100.6 fL | "reference range" |
| above 100.6 fL | No name given |
Derived the same way from the 1999 to 2004 survey sample [3].
US national survey laboratory procedure manual, 2017 to 2018, boys aged 1 to 5
Boys aged 1 to 5, as the reference range used by the survey laboratory · [3]
| Range | What the source calls it |
|---|---|
| below 68.2 fL | No name given |
| 68.2 to 88.8 fL | "reference range" |
| above 88.8 fL | No name given |
Derived the same way from the 1999 to 2004 survey sample [3].
US national survey laboratory procedure manual, 2017 to 2018, boys aged 6 to 18
Boys aged 6 to 18, as the reference range used by the survey laboratory · [3]
| Range | What the source calls it |
|---|---|
| below 75.6 fL | No name given |
| 75.6 to 94.6 fL | "reference range" |
| above 94.6 fL | No name given |
Derived the same way from the 1999 to 2004 survey sample [3].
US national survey laboratory procedure manual, 2017 to 2018, girls aged 1 to 5
Girls aged 1 to 5, as the reference range used by the survey laboratory · [3]
| Range | What the source calls it |
|---|---|
| below 70.2 fL | No name given |
| 70.2 to 89.1 fL | "reference range" |
| above 89.1 fL | No name given |
Derived the same way from the 1999 to 2004 survey sample [3].
US national survey laboratory procedure manual, 2017 to 2018, girls aged 6 to 18
Girls aged 6 to 18, as the reference range used by the survey laboratory · [3]
| Range | What the source calls it |
|---|---|
| below 74.7 fL | No name given |
| 74.7 to 94.9 fL | "reference range" |
| above 94.9 fL | No name given |
Derived the same way from the 1999 to 2004 survey sample [3].
Nordic Reference Interval Project, 2004
Adults aged 18 to 90 in Denmark, Finland, Iceland, Norway and Sweden · [5]
| Range | What the source calls it |
|---|---|
| below 82 fL | No name given |
| 82 to 98 fL | "reference interval" |
| above 98 fL | No name given |
The 2.5th to 97.5th percentiles in 1,826 healthy men and women, measured on 12 types of analyzer in 60 laboratories. One interval is given for both sexes [5].
US Centers for Disease Control and Prevention recommendations, 1998, people older than 15
People older than 15 years who are being assessed for anemia · [2]
| Range | What the source calls it |
|---|---|
| below 85 fL | "microcytic anemia" |
| 85 or above fL | No name given |
A cutoff for calling an anemia microcytic, set at the 5th percentile for age in the third US National Health and Nutrition Examination Survey. It is meant for someone already found to be anemic, and a value under it is not by itself a diagnosis. The source gives no cutoff for high values, so this block does not classify them [2].
US Centers for Disease Control and Prevention recommendations, 1998, children aged 12 to 15
Children aged 12 to 15 years who are being assessed for anemia · [2]
| Range | What the source calls it |
|---|---|
| below 82 fL | "microcytic anemia" |
| 82 or above fL | No name given |
Set the same way, at the 5th percentile for age. No cutoff for high values [2].
US Centers for Disease Control and Prevention recommendations, 1998, children aged 6 to 11
Children aged 6 to 11 years who are being assessed for anemia · [2]
| Range | What the source calls it |
|---|---|
| below 80 fL | "microcytic anemia" |
| 80 or above fL | No name given |
Set the same way, at the 5th percentile for age. No cutoff for high values [2].
US Centers for Disease Control and Prevention recommendations, 1998, children aged 3 to 5
Children aged 3 to 5 years who are being assessed for anemia · [2]
| Range | What the source calls it |
|---|---|
| below 79 fL | "microcytic anemia" |
| 79 or above fL | No name given |
Set the same way, at the 5th percentile for age. No cutoff for high values [2].
US Centers for Disease Control and Prevention recommendations, 1998, children aged 1 to 2
Children aged 1 to 2 years who are being assessed for anemia · [2]
| Range | What the source calls it |
|---|---|
| below 77 fL | "microcytic anemia" |
| 77 or above fL | No name given |
Set the same way, at the 5th percentile for age. No cutoff for high values [2].
How it compares with the reference method
Mixed results1
Variation from one draw to the next in one person
Shown to vary about 0.8% from one draw to the next within the same person, in a pooled estimate from a European laboratory federation.
The numbers and sources
- Compared with
- The same person's results on repeated venous draws
- Effect
- The European Federation of Clinical Chemistry and Laboratory Medicine database gives a pooled within-person variation of 0.8% for MCV, with lower and upper limits of 0.6% and 1.7%, from 9 included estimates. Variation between people is 3.9% [12]. At an MCV of 90 fL, 0.8% is about 0.7 fL.
- Population
- Healthy adults in the studies the database pools [12].
- Sources
- [12]
- Caveats
- A summary across studies in healthy volunteers. The database states no threshold for agreement, so the result is given as numbers only [12]. The US survey manual lists a very high white cell count, many very large platelets and clumped or rigid red cells as things that can distort the reading [3].
What studies tie it to
Linked in research4
Iron deficiency at low values
Limited evidence: in one US survey analysis, MCV told iron-deficient from iron-replete women and children moderately well, and less well than hemoglobin in women.
The numbers and sources
- Effect
- Against iron deficiency defined by body iron stores, the area under the curve for MCV was 0.73 in children aged 3 to 5, 0.80 in nonpregnant women aged 15 to 49 and 0.70 in pregnant women. Hemoglobin scored 0.62, 0.84 and 0.74 in the same groups, and erythrocyte protoporphyrin 0.80, 0.86 and 0.77 [6]. The US recommendations state that a low MCV is a specific sign of iron-deficiency anemia once lead poisoning, the anemias of infection and chronic inflammatory disease, and thalassemia minor are excluded [2].
- Population
- 861 children aged 3 to 5, 3,112 nonpregnant women and 1,150 pregnant women in US national surveys from 1999 to 2006, excluding those with raised lead or C-reactive protein [6].
- Sources
- [6], [2]
- Caveats
- A cross-sectional analysis in US children and women, with iron stores estimated from two blood tests, not from bone marrow. It did not include men [6].
Thalassemia trait at low values
Limited evidence: in one Thai study of pregnant women, an MCV of 80 fL or below picked up 93% of thalassemia trait carriers.
The numbers and sources
- Effect
- An MCV of 80 fL or below had a sensitivity of 92.9% and a specificity of 83.9% for alpha-thalassemia-1 and beta-thalassemia traits. The positive predictive value was 37.9% and the negative predictive value 99.1% [7].
- Population
- 439 pregnant women at one antenatal clinic in Chiang Mai, Thailand, each tested by hemoglobin analysis and gene testing [7].
- Sources
- [7]
- Caveats
- One clinic in a region where thalassemia traits are common, so the predictive values do not carry over to places where they are rare. About 6 in 10 women with a low MCV did not carry either trait [7].
Conditions found in people with a high MCV
Limited evidence: in one hospital series of 300 adults with an MCV of 100 fL or above, drug therapy, alcohol and liver disease were the most common explanations.
The numbers and sources
- Effect
- The most common cause was drug therapy, followed by alcohol, liver disease and a raised count of young red cells. Megaloblastic blood formation, the pattern seen in vitamin B12 and folate deficiency, accounted for less than 10% of cases. MCV values above 120 fL were usually caused by B12 deficiency [9].
- Population
- 300 consecutive hospitalized adults with an MCV of 100 fL or above at a New York City teaching hospital [9].
- Sources
- [9]
- Caveats
- Hospitalized patients at one center, so the mix of causes is not that of people tested as outpatients. The abstract gives the order of causes without a percentage for each [9].
Death from any cause and from heart and vessel disease
Linked to more deaths at higher MCV in two East Asian cohorts, including a 44% to 55% higher death rate in the top quarter of non-anemic Korean adults.
The numbers and sources
- Effect
- In non-anemic Korean adults, the top quarter of MCV (95.8 fL or above in men, 94.2 fL or above in women) had adjusted hazard ratios for death from any cause of 1.44 (95% CI 1.15 to 1.80) in men and 1.55 (1.08 to 2.22) in women, against a reference group at 90.5 to 93.0 fL in men and 89.2 to 91.6 fL in women. In men the hazard ratio for death from liver cancer was 3.55 (1.75 to 7.21) [10]. In a Taiwanese community cohort, higher MCV went with more deaths from stroke and heart disease combined (adjusted hazard ratio 1.42, P for trend 0.012) [11].
- Population
- 36,260 adults aged 40 and older having routine check-ups in Seoul, 1,107 deaths over a mean 8.0 years [10]. 66,294 adults aged 20 and older in Keelung, Taiwan, followed 9 years [11].
- Sources
- [10], [11]
- Caveats
- Observational, in two East Asian populations. The Taiwanese abstract does not state which MCV levels were compared, and its findings for single causes of death did not reach significance [11]. Neither study shows that MCV itself changes risk.
Mixed results1
Vitamin B12 deficiency at high values
Mixed results: a raised MCV picked up 17% to 77% of vitamin B12 deficiency depending on the group studied, so many deficient people had an MCV that was not raised.
The numbers and sources
- Effect
- In a systematic review, the sensitivity of a raised MCV for B12 deficiency was 17% in people screened at random and 30% in screened people with anemia. Where B12 was measured as part of care, sensitivity was 30% for a low serum B12, 58% for confirmed deficiency and 75% for deficiency with anemia. In pernicious anemia it was 77%. The positive predictive value ranged from 0% to 55% in the 5 studies reporting it. The authors calculate that up to 84% of cases would be missed if a raised MCV were the only reason to test [8].
- Population
- 37 original studies of anemic and non-anemic patients [8].
- Sources
- [8]
- Caveats
- Studies used different cut points for both MCV and serum B12, and results were pooled without taking these into account [8].
Sources
- US Food and Drug Administration. 21 CFR 864.5200, Automated cell counter. Electronic Code of Federal Regulations. https://www.ecfr.gov/current/title-21/section-864.5200
- Centers for Disease Control and Prevention. Recommendations to Prevent and Control Iron Deficiency in the United States. MMWR Recommendations and Reports. 1998;47(RR-3). https://www.cdc.gov/mmwr/preview/mmwrhtml/00051880.htm
- Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey 2017-2018 Laboratory Procedure Manual: Complete Blood Count, whole blood, Beckman Coulter DxH 800 analyzer. Performed by the NHANES Mobile Examination Center. https://wwwn.cdc.gov/nchs/data/nhanes/public/2017/labmethods/CBC-J-MET-508.pdf
- Hoffmann JJ, Nabbe KC, van den Broek NM. Effect of age and gender on reference intervals of red blood cell distribution width (RDW) and mean red cell volume (MCV). Clinical Chemistry and Laboratory Medicine. 2015. https://doi.org/10.1515/cclm-2015-0155
- Nordin G, Mårtensson A, Swolin B, et al. A multicentre study of reference intervals for haemoglobin, basic blood cell counts and erythrocyte indices in the adult population of the Nordic countries. Scandinavian Journal of Clinical and Laboratory Investigation. 2004. https://doi.org/10.1080/00365510410002797
- Mei Z, Flores-Ayala RC, Grummer-Strawn LM, et al. Is Erythrocyte Protoporphyrin a Better Single Screening Test for Iron Deficiency Compared to Hemoglobin or Mean Cell Volume in Children and Women? Nutrients. 2017. https://doi.org/10.3390/nu9060557
- Sirichotiyakul S, Maneerat J, Sa-nguansermsri T, et al. Sensitivity and specificity of mean corpuscular volume testing for screening for alpha-thalassemia-1 and beta-thalassemia traits. Journal of Obstetrics and Gynaecology Research. 2005. https://doi.org/10.1111/j.1447-0756.2005.00280.x
- Oosterhuis WP, Niessen RW, Bossuyt PM, et al. Diagnostic value of the mean corpuscular volume in the detection of vitamin B12 deficiency. Scandinavian Journal of Clinical and Laboratory Investigation. 2000. https://doi.org/10.1080/00365510050184994
- Savage DG, Ogundipe A, Allen RH, et al. Etiology and Diagnostic Evaluation of Macrocytosis. The American Journal of the Medical Sciences. 2000. https://doi.org/10.1097/00000441-200006000-00001
- Yoon HJ, Kim K, Nam YS, et al. Mean corpuscular volume levels and all-cause and liver cancer mortality. Clinical Chemistry and Laboratory Medicine. 2016. https://doi.org/10.1515/cclm-2015-0786
- Wu TH, Fann JC, Chen SL, et al. Gradient Relationship between Increased Mean Corpuscular Volume and Mortality Associated with Cerebral Ischemic Stroke and Ischemic Heart Disease: A Longitudinal Study on 66,294 Taiwanese. Scientific Reports. 2018. https://doi.org/10.1038/s41598-018-34403-w
- European Federation of Clinical Chemistry and Laboratory Medicine. EFLM Biological Variation Database, meta-analysis estimates, read 2026-11-13. https://biologicalvariation.eu/