Red blood cell distribution width

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Red blood cell distribution width
Redbloodcells.jpg
Human red blood cells
Synonyms RCDW
Purposemeasure of the range of variation of red blood cell volume that is reported as part of a standard complete blood count.

Red blood cell distribution width (RDW), as well as various types thereof (RDW-CV or RCDW and RDW-SD), is a measure of the range of variation of red blood cell (RBC) volume that is reported as part of a standard complete blood count. [1] Red blood cells have an average volume of 80-100 femtoliters, but individual cell volumes vary even in healthy blood. [1] Certain disorders, however, cause a significantly increased variation in cell size. Higher RDW values indicate greater variation in size. Normal reference range of RDW-CV in human red blood cells is 11.5–15.4%. [2] [1] If anemia is observed, RDW test results are often used together with mean corpuscular volume (MCV) results to determine the possible causes of the anemia. It is mainly used to differentiate an anemia of mixed causes from an anemia of a single cause.

Contents

Deficiencies of Vitamin B12 or folate produce a macrocytic anemia (large cell anemia) in which the RDW is elevated in roughly two-thirds of all cases. However, a varied size distribution of red blood cells is a hallmark of iron deficiency anemia, and as such shows an increased RDW in virtually all cases. In the case of both iron and B12 deficiencies, there will normally be a mix of both large cells and small cells, causing the RDW to be elevated. An elevated RDW (red blood cells of unequal sizes) is known as anisocytosis. [3]

An elevation in the RDW is not characteristic of all anemias. Anemia of chronic disease, hereditary spherocytosis, acute blood loss, aplastic anemia (anemia resulting from an inability of the bone marrow to produce red blood cells), and certain hereditary hemoglobinopathies (including some cases of thalassemia minor) may all present with a normal RDW. [4]

Calculations

The "width" in RDW is sometimes thought to be "misleading", since it in fact is a measure of deviation of the volume of RBCs, and not directly the diameter. However, "width" refers to the width of the volume curve (distribution width), not the width of the cells. [5] [6]

RDW-SD is calculated as the width (in fL) of the RBC size distribution histogram at the 20% height level. This parameter is, therefore, not influenced by the average RBC size (mean corpuscular volume, MCV). [7]

RDW-CV (expressed in %) is calculated with the following formula:

RDW-CV = (1 standard deviation of RBC volume ÷ MCV) × 100%. [8]

Since RDW-CV is mathematically derived from MCV, it is therefore affected by the average RBC size (MCV). [7]

Pathological implications

Normal RDW

Anemia in the presence of a normal RDW may suggest thalassemia. A low Mentzer Index, calculated from CBC data [MCV/RBC < 13], may suggest this disorder but a hemoglobin electrophoresis would be diagnostic. Anemia of chronic diseases show normal RDW.[ citation needed ]

High RDW

High RDW may be a result of the presence of fragments, groups of agglutination, and/or abnormal shape of red blood cells. [7]

By severity, elevated RDW can be classified as follows:

RDW in adults [9] Severity [9] Most notable causes [9]
14.5% - 18%Mild anisocytosisInfection, vigorous exercise or certain drugs. Iron deficiency anemia in the presence of anemia and microcytosis.
18% - 26%Moderate anisocytosisSevere iron deficiency anemia, megaloblastic anemia.
> 26%Severe anisocytosisSideroblastic anemia

Related Research Articles

<span class="mw-page-title-main">Anemia</span> Medical condition

Anemia or anaemia is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. The name is derived from Ancient Greek: ἀναιμία anaimia, meaning 'lack of blood', from ἀν- an-, 'not' and αἷμα haima, 'blood'. When anemia comes on slowly, the symptoms are often vague, such as tiredness, weakness, shortness of breath, headaches, and a reduced ability to exercise. When anemia is acute, symptoms may include confusion, feeling like one is going to pass out, loss of consciousness, and increased thirst. Anemia must be significant before a person becomes noticeably pale. Symptoms of anemia depend on how quickly hemoglobin decreases. Additional symptoms may occur depending on the underlying cause. Preoperative anemia can increase the risk of needing a blood transfusion following surgery. Anemia can be temporary or long term and can range from mild to severe.

<span class="mw-page-title-main">Complete blood count</span> Routine laboratory test of blood cells

A complete blood count (CBC), also known as a full blood count (FBC), is a set of medical laboratory tests that provide information about the cells in a person's blood. The CBC indicates the counts of white blood cells, red blood cells and platelets, the concentration of hemoglobin, and the hematocrit. The red blood cell indices, which indicate the average size and hemoglobin content of red blood cells, are also reported, and a white blood cell differential, which counts the different types of white blood cells, may be included.

<span class="mw-page-title-main">Hematocrit</span> Volume percentage of red blood cells in blood

The hematocrit, also known by several other names, is the volume percentage (vol%) of red blood cells (RBCs) in blood, measured as part of a blood test. The measurement depends on the number and size of red blood cells. It is normally 40.7–50.3% for males and 36.1–44.3% for females. It is a part of a person's complete blood count results, along with hemoglobin concentration, white blood cell count and platelet count.

<span class="mw-page-title-main">Hereditary spherocytosis</span> Medical condition

Hereditary spherocytosis (HS) is a congenital hemolytic disorder, wherein a genetic mutation coding for a structural membrane protein phenotype leads to a spherical shaping of erythrocytic cellular morphology. As erythrocytes are sphere-shaped (spherocytosis), rather than the normal biconcave disk-shaped, their morphology interferes with these cells' abilities to be flexible during circulation throughout the entirety of the body - arteries, arterioles, capillaries, venules, veins, and organs. This difference in shape also makes the red blood cells more prone to rupture under osmotic and/or mechanical stress. Cells with these dysfunctional proteins are degraded in the spleen, which leads to a shortage of erythrocytes resulting in hemolytic anemia.

<span class="mw-page-title-main">Pernicious anemia</span> Anemia caused by vitamin B12 deficiency

Pernicious anemia is a disease in which not enough red blood cells are produced due to a deficiency of vitamin B12. Those affected often have a gradual onset. The most common initial symptoms are feeling tired and weak. Other symptoms of anemia may include shortness of breath, lightheadedness, headaches, sore red tongue, cold hands and feet, pale or yellow skin, chest pain, and an irregular heartbeat. The digestive tract may also be disturbed giving symptoms that can include nausea and vomiting, heartburn, upset stomach and loss of appetite. Symptoms of vitamin B12 deficiency may include decreased ability to think, numbness in the hands and feet, memory problems, blurred vision, trouble walking, poor balance, muscle weakness, decreased smell and taste, poor reflexes, clumsiness, depression, and confusion. Without treatment, some of these problems may become permanent.

<span class="mw-page-title-main">Mean corpuscular hemoglobin</span> Average mass of hemoglobin (Hb) per red blood cell (RBC)

The mean corpuscular hemoglobin, or "mean cell hemoglobin" (MCH), is the average mass of hemoglobin (Hb) per red blood cell (RBC) in a sample of blood. It is reported as part of a standard complete blood count. MCH value is diminished in hypochromic anemias.

The mean corpuscular volume, or mean cell volume (MCV), is a measure of the average volume of a red blood corpuscle. The measure is obtained by multiplying a volume of blood by the proportion of blood that is cellular, and dividing that product by the number of erythrocytes in that volume. The mean corpuscular volume is a part of a standard complete blood count.

<span class="mw-page-title-main">Megaloblastic anemia</span> Medical condition

Megaloblastic anemia is a type of macrocytic anemia. An anemia is a red blood cell defect that can lead to an undersupply of oxygen. Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the G2 growth stage to the mitosis (M) stage. This leads to continuing cell growth without division, which presents as macrocytosis. Megaloblastic anemia has a rather slow onset, especially when compared to that of other anemias. The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency. Loss of micronutrients may also be a cause.

<span class="mw-page-title-main">Microcytic anemia</span> Medical condition

Microcytic anaemia is any of several types of anemia characterized by smaller than normal red blood cells. The normal mean corpuscular volume is approximately 80–100 fL. When the MCV is <80 fL, the red cells are described as microcytic and when >100 fL, macrocytic. The MCV is the average red blood cell size.

Macrocytosis is the enlargement of red blood cells with near-constant hemoglobin concentration, and is defined by a mean corpuscular volume (MCV) of greater than 100 femtolitres. The enlarged erythrocytes are called macrocytes or megalocytes. As a symptom its cause may be relatively benign and need no treatment or it may indicate a serious underlying illness.

The Mentzer index, described in 1973 by William C. Mentzer, is the MCV divided by the RBC count. It is said to be helpful in differentiating iron deficiency anemia from beta thalassemia trait.

<span class="mw-page-title-main">Hypochromic anemia</span> Medical condition

Hypochromic anemia is a generic term for any type of anemia in which the red blood cells are paler than normal. A normal red blood cell has a biconcave disk shape and will have an area of pallor in its center when viewed microscopically. In hypochromic cells, this area of central pallor is increased. This decrease in redness is due to a disproportionate reduction of red cell hemoglobin in proportion to the volume of the cell. Clinically the color can be evaluated by the mean corpuscular hemoglobin (MCH) or mean corpuscular hemoglobin concentration (MCHC). The MCHC is considered the better parameter of the two as it adjusts for effect the size of the cell has on its amount of hemoglobin. Hypochromia is clinically defined as below the normal MCH reference range of 27–33 picograms/cell in adults or below the normal MCHC reference range of 33–36 g/dL in adults.

<span class="mw-page-title-main">Anisocytosis</span> Medical condition

Anisocytosis is a medical term meaning that a patient's red blood cells are of unequal size. This is commonly found in anemia and other blood conditions. False diagnostic flagging may be triggered on a complete blood count by an elevated WBC count, agglutinated RBCs, RBC fragments, giant platelets or platelet clumps. In addition, it is a characteristic feature of bovine blood.

The term macrocytic is from Greek words meaning "large cell". A macrocytic class of anemia is an anemia in which the red blood cells (erythrocytes) are larger than their normal volume. The normal erythrocyte volume in humans is about 80 to 100 femtoliters. In metric terms the size is given in equivalent cubic micrometers. The condition of having erythrocytes which are too large, is called macrocytosis. In contrast, in microcytic anemia, the erythrocytes are smaller than normal.

Red blood cell indices are blood tests that provide information about the hemoglobin content and size of red blood cells. Abnormal values indicate the presence of anemia and which type of anemia it is.

Hematologic diseases are disorders which primarily affect the blood & blood-forming organs. Hematologic diseases include rare genetic disorders, anemia, HIV, sickle cell disease & complications from chemotherapy or transfusions.

Microcytosis or microcythemia is a condition in which red blood cells are unusually small as measured by their mean corpuscular volume.

Normocytic anemia is a type of anemia and is a common issue that occurs for men and women typically over 85 years old. Its prevalence increases with age, reaching 44 percent in men older than 85 years. The most common type of normocytic anemia is anemia of chronic disease.


Anemia is a deficiency in the size or number of red blood cells or in the amount of hemoglobin they contain. This deficiency limits the exchange of O2 and CO2 between the blood and the tissue cells. Globally, young children, women, and older adults are at the highest risk of developing anemia. Anemia can be classified based on different parameters, and one classification depends on whether it is related to nutrition or not so there are two types: nutritional anemia and non-nutritional anemia. Nutritional anemia refers to anemia that can be directly attributed to nutritional disorders or deficiencies. Examples include Iron deficiency anemia and pernicious anemia. It is often discussed in a pediatric context.

Anemia is a condition in which blood has a lower-than-normal amount of red blood cells or hemoglobin. Anemia in pregnancy is a decrease in the total red blood cells (RBCs) or hemoglobin in the blood during pregnancy. Anemia is an extremely common condition in pregnancy world-wide, conferring a number of health risks to mother and child. While anemia in pregnancy may be pathologic, in normal pregnancies, the increase in RBC mass is smaller than the increase in plasma volume, leading to a mild decrease in hemoglobin concentration referred to as physiologic anemia. Maternal signs and symptoms are usually non-specific, but can include: fatigue, pallor, dyspnea, palpitations, and dizziness. There are numerous well-known maternal consequences of anemia including: maternal cardiovascular strain, reduced physical and mental performance, reduced peripartum blood reserves, increased risk for peripartum blood product transfusion, and increased risk for maternal mortality.

References

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  2. "Red Cell Distribution Width". Family Practice Notebook. Retrieved 18 October 2013.
  3. Evans TC, Jehle D (1991). "The red blood cell distribution width". The Journal of Emergency Medicine. 9 (Suppl 1): 71–4. doi:10.1016/0736-4679(91)90592-4. PMID   1955687.
  4. Kjeldsberg CR, Perkins SL (2010). "Table 1.4". Practical Diagnosis of Hematologic Disorders (5th ed.). Chicago, IL: ASCP Press. ISBN   978-0-89189-571-8. Archived from the original on 25 July 2013.
  5. Pomeranian Medical University > Red blood cell indices (indexes) [ permanent dead link ] Retrieved on 5 April 2009
  6. Cornell University, Department of Population Medicine & Diagnostic Sciences > Red Cell Distribution Width (RDW) Last Updated: June 2000. Retrieved on 5 April 2009
  7. 1 2 3 Curry, Choladda Vejabhuti (7 January 2017). "Red Cell Distribution Width (RDW): Reference Range, Interpretation, Collection and Panels". Medscape Reference. Retrieved 18 May 2019.
  8. Encyclopedia of Surgery: A Guide for Patients and Caregivers Red blood cell indices Retrieved on 5 April 2009
  9. 1 2 3 "High RDW level in the blood". MrLabTest. Last update: 12/01/2021

Further reading