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Mean corpuscular volume

Stanley L Schrier, MD
Section Editor
William C Mentzer, MD
Deputy Editor
Jennifer S Tirnauer, MD


The mean corpuscular volume (MCV) is one of the standard red blood cell (RBC) "indices" (table 1). It is the volume of the "average" RBC, stated in femtoliters (fL, 10-15 L). Measurement of the MCV and its importance in the differential diagnosis of anemia will be discussed here [1]. Control of RBC hydration, which directly influences the MCV, is discussed separately. (See "Control of red blood cell hydration".)

A general approach to the patient with anemia is presented separately. (See "Approach to the adult patient with anemia".)


The mean corpuscular volume (MCV) can be measured or calculated in a number of different ways (see "Automated hematology instrumentation"):

Use of volume-sensitive automated blood cell counters, such as the Coulter counter. In this type of apparatus, the red cells pass one-by-one through a small aperture and generate a signal directly proportional to their volume.

Other automated counters measure red blood cell (RBC) volume by means of techniques that measure refracted, diffracted, or scattered light.


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Literature review current through: Jan 2016. | This topic last updated: Apr 27, 2015.
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  1. Brugnara C, Mohandas N. Red cell indices in classification and treatment of anemias: from M.M. Wintrobes's original 1934 classification to the third millennium. Curr Opin Hematol 2013; 20:222.
  2. Saxena S, Weiner JM, Carmel R. Red blood cell distribution width in untreated pernicious anemia. Am J Clin Pathol 1988; 89:660.
  3. Harkins LS, Sirel JM, McKay PJ, et al. Discriminant analysis of macrocytic red cells. Clin Lab Haematol 1994; 16:225.
  4. Eldibany MM, Totonchi KF, Joseph NJ, Rhone D. Usefulness of certain red blood cell indices in diagnosing and differentiating thalassemia trait from iron-deficiency anemia. Am J Clin Pathol 1999; 111:676.
  5. Madan N, Sikka M, Sharma S, et al. Red cell indices and discriminant functions in the detection of beta-thalassaemia trait in a population with high prevalence of iron deficiency anaemia. Indian J Pathol Microbiol 1999; 42:55.
  6. AlFadhli SM, Al-Awadhi AM, AlKhaldi D. Validity assessment of nine discriminant functions used for the differentiation between iron deficiency anemia and thalassemia minor. J Trop Pediatr 2007; 53:93.
  7. Ferrara M, Capozzi L, Russo R, et al. Reliability of red blood cell indices and formulas to discriminate between beta thalassemia trait and iron deficiency in children. Hematology 2010; 15:112.
  8. Schoorl M, Schoorl M, Linssen J, et al. Efficacy of advanced discriminating algorithms for screening on iron-deficiency anemia and β-thalassemia trait: a multicenter evaluation. Am J Clin Pathol 2012; 138:300.
  9. Veeranna V, Zalawadiya SK, Panaich S, et al. Comparative analysis of red cell distribution width and high sensitivity C-reactive protein for coronary heart disease mortality prediction in multi-ethnic population: findings from the 1999-2004 NHANES. Int J Cardiol 2013; 168:5156.
  10. Ueda T, Kawakami R, Horii M, et al. High mean corpuscular volume is a new indicator of prognosis in acute decompensated heart failure. Circ J 2013; 77:2766.
  11. Rezende SM, Lijfering WM, Rosendaal FR, Cannegieter SC. Hematologic variables and venous thrombosis: red cell distribution width and blood monocyte count are associated with an increased risk. Haematologica 2014; 99:194.
  12. Tonelli M, Sacks F, Arnold M, et al. Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease. Circulation 2008; 117:163.
  13. Poludasu S, Marmur JD, Weedon J, et al. Red cell distribution width (RDW) as a predictor of long-term mortality in patients undergoing percutaneous coronary intervention. Thromb Haemost 2009; 102:581.
  14. Kurt M, Tanboga IH, Buyukkaya E, et al. Relation of red cell distribution width with CHA2DS2-VASc score in patients with nonvalvular atrial fibrillation. Clin Appl Thromb Hemost 2014; 20:687.
  15. Güngör B, Özcan KS, Erdinler İ, et al. Elevated levels of RDW is associated with non-valvular atrial fibrillation. J Thromb Thrombolysis 2014; 37:404.
  16. Adamsson Eryd S, Borné Y, Melander O, et al. Red blood cell distribution width is associated with incidence of atrial fibrillation. J Intern Med 2014; 275:84.
  17. Providência R, Ferreira MJ, Gonçalves L, et al. Mean corpuscular volume and red cell distribution width as predictors of left atrial stasis in patients with non-valvular atrial fibrillation. Am J Cardiovasc Dis 2013; 3:91.
  18. Saliba W, Barnett-Griness O, Elias M, Rennert G. The association between red cell distribution width and stroke in patients with atrial fibrillation. Am J Med 2015; 128:192.e11.
  19. Kim J, Kim YD, Song TJ, et al. Red blood cell distribution width is associated with poor clinical outcome in acute cerebral infarction. Thromb Haemost 2012; 108:349.
  20. Aung N, Dworakowski R, Byrne J, et al. Progressive rise in red cell distribution width is associated with poor outcome after transcatheter aortic valve implantation. Heart 2013; 99:1261.
  21. Allen LA, Felker GM, Mehra MR, et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail 2010; 16:230.
  22. Lippi G, Sanchis-Gomar F, Danese E, Montagnana M. Association of red blood cell distribution width with plasma lipids in a general population of unselected outpatients. Kardiol Pol 2013; 71:931.
  23. Solak Y, Yilmaz MI, Saglam M, et al. Red cell distribution width is independently related to endothelial dysfunction in patients with chronic kidney disease. Am J Med Sci 2014; 347:118.
  24. Ujszaszi A, Molnar MZ, Czira ME, et al. Renal function is independently associated with red cell distribution width in kidney transplant recipients: a potential new auxiliary parameter for the clinical evaluation of patients with chronic kidney disease. Br J Haematol 2013; 161:715.
  25. Afonso L, Zalawadiya SK, Veeranna V, et al. Relationship between red cell distribution width and microalbuminuria: a population-based study of multiethnic representative US adults. Nephron Clin Pract 2011; 119:c277.
  26. Majercik S, Fox J, Knight S, Horne BD. Red cell distribution width is predictive of mortality in trauma patients. J Trauma Acute Care Surg 2013; 74:1021.
  27. Garbharran U, Chinthapalli S, Hopper I, et al. Red cell distribution width is an independent predictor of mortality in hip fracture. Age Ageing 2013; 42:258.
  28. Balta S, Demirkol S, Hatipoglu M, et al. Red cell distribution width is a predictor of mortality in patients with severe sepsis and septic shock. Am J Emerg Med 2013; 31:989.
  29. Jo YH, Kim K, Lee JH, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med 2013; 31:545.
  30. Balta S, Demirkol S, Cakar M, et al. Red cell distribution width: a novel and simple predictor of mortality in acute pancreatitis. Am J Emerg Med 2013; 31:991.
  31. Şenol K, Saylam B, Kocaay F, Tez M. Red cell distribution width as a predictor of mortality in acute pancreatitis. Am J Emerg Med 2013; 31:687.
  32. Kim HM, Kim BS, Cho YK, et al. Elevated red cell distribution width is associated with advanced fibrosis in NAFLD. Clin Mol Hepatol 2013; 19:258.
  33. Demir R, Saritemur M, Ozel L, et al. Red cell distribution width identifies cerebral venous sinus thrombosis in patients with headache. Clin Appl Thromb Hemost 2015; 21:354.
  34. Lam AP, Gundabolu K, Sridharan A, et al. Multiplicative interaction between mean corpuscular volume and red cell distribution width in predicting mortality of elderly patients with and without anemia. Am J Hematol 2013; 88:E245.
  35. Patel KV, Ferrucci L, Ershler WB, et al. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009; 169:515.
  36. Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009; 169:588.
  37. Horne BD, May HT, Muhlestein JB, et al. Exceptional mortality prediction by risk scores from common laboratory tests. Am J Med 2009; 122:550.
  38. Jaiswal S, Fontanillas P, Flannick J, et al. Age-related clonal hematopoiesis associated with adverse outcomes. N Engl J Med 2014; 371:2488.
  39. Grant BJ, Kudalkar DP, Muti P, et al. Relation between lung function and RBC distribution width in a population-based study. Chest 2003; 124:494.
  40. Garcez ME, Peres W, Salvador M. Oxidative stress and hematologic and biochemical parameters in individuals with Down syndrome. Mayo Clin Proc 2005; 80:1607.
  41. Kobayashi S, Moriya H, Aso K, Ohtake T. Vitamin E-bonded hemodialyzer improves atherosclerosis associated with a rheological improvement of circulating red blood cells. Kidney Int 2003; 63:1881.
  42. Patel HH, Patel HR, Higgins JM. Modulation of red blood cell population dynamics is a fundamental homeostatic response to disease. Am J Hematol 2015; 90:422.
  43. Uprichard J, Dorling D, Bain BJ. A dimorphic blood film as a sign of the onset of iron-deficient erythropoiesis in megaloblastic anemia. Am J Hematol 2012; 87:1046.
  44. Planas AT, Van Voolen GA, Kelly LA. Hyperglycemic macrocytosis in electronically determined mean corpuscular volume. Use of three different automatic cell counters. Ann Clin Lab Sci 1985; 15:286.
  45. Holt JT, DeWandler MJ, Arvan DA. Spurious elevation of the electronically determined mean corpuscular volume and hematocrit caused by hyperglycemia. Am J Clin Pathol 1982; 77:561.
  46. van Duijnhoven HL, Treskes M. Marked interference of hyperglycemia in measurements of mean (red) cell volume by Technicon H analyzers. Clin Chem 1996; 42:76.
  47. Hinchliffe RF, Bellamy GJ, Lilleyman JS. Use of the Technicon H1 hypochromia flag in detecting spurious macrocytosis induced by excessive K2-EDTA concentration. Clin Lab Haematol 1992; 14:268.
  48. Kim AH, Jang W, Kim Y, et al. Mean corpuscular volume (MCV) values reflect therapeutic effectiveness in zidovudine-receiving HIV patients. J Clin Lab Anal 2013; 27:373.
  49. Camaschella C. How I manage patients with atypical microcytic anaemia. Br J Haematol 2013; 160:12.
  50. Athiyarath R, Arora N, Fuster F, et al. Two novel missense mutations in iron transport protein transferrin causing hypochromic microcytic anaemia and haemosiderosis: molecular characterization and structural implications. Br J Haematol 2013; 163:404.
  51. DeLoughery TG. Microcytic anemia. N Engl J Med 2014; 371:1324.
  52. Thompson WG, Meola T, Lipkin M Jr, Freedman ML. Red cell distribution width, mean corpuscular volume, and transferrin saturation in the diagnosis of iron deficiency. Arch Intern Med 1988; 148:2128.
  53. Seward SJ, Safran C, Marton KI, Robinson SH. Does the mean corpuscular volume help physicians evaluate hospitalized patients with anemia? J Gen Intern Med 1990; 5:187.
  54. Marsh WL Jr, Bishop JW, Darcy TP. Evaluation of red cell volume distribution width (RDW). Hematol Pathol 1987; 1:117.