Red blood cell distribution width in untreated pernicious anemia

The red blood cell distribution width (RDW) was studied in 26 unselected patients with untreated pernicious anemia. RDW changes were also sequentially followed after therapy in 12 patients. The mean (+/- 1 SD) RDW values were significantly higher in pernicious anemia patients than in controls (21.7 +/- 9.1% vs. 13.2 +/- 1.1%, P less than 0.0001). Nevertheless, 31% of the patients had normal RDWs. There were no consistent findings among those who had normal RDW. Most of them were in the early stages of deficiency, but some had advanced deficiency. Over half of those with normal RDW also had normal mean corpuscular volume (MCV). Overall, 9 of the 26 patients (35%) had normal MCV. Of eight patients whose RDW fell with therapy, some showed a steady fall while others had a transient rise followed by a progressive drop. Despite current advocacy that a high RDW is a sensitive and consistent finding in vitamin B12 deficiency, our findings show that a large proportion of untreated pernicious anemia patients have normal RDWs and that in contrast to iron deficiency, elevation of RDW is not necessarily the earliest indicator of vitamin B12 deficiency.     

Red blood cell distribution width index in some hematologic diseases

The red blood cell distribution width index (RDW) was determined in a group of anemic male patients and normal male blood donors. Elevated mean RDW values were found in the anemic patients, with the highest value seen in sickle cell anemia, sickle cell-beta thalassemia, sickle cell trait, beta-thalassemia trait, and iron deficiency in decreasing order of magnitude. The mean RDW of the normal male subjects was 11.3. It was found that the RDW was proportional to the reticulocyte count, with the highest values in the patients with the highest reticulocyte count (sickle cell anemia). One clinical value of the RDW therefore may lie in its capacity for reflecting active erythropoiesis. For example, patients with normal or near-normal hemoglobin and with high RDWs may be suspected of having an elevated reticulocyte count that may indicate a hemoglobinopathy, such as sickle cell trait or thalassemia trait.     

Red cell distribution width in sickle cell disease

Red cell distribution width (RDW), an electronically determined index of anisocytosis, was examined in 60 patients with sickle cell anemia (Hb SS), 28 patients with hemoglobin sickle cell (SC) disease, and seven patients with sickle cell-beta(+) thalassemia (S-thal). All patients were adults and in the steady state of their disease. The RDW was greater in sickle cell patients than in 39 healthy, age and race matched controls without hemoglobinopathy (Hb AA). Patients with sickle cell anemia had higher mean RDW than those with Hb SC disease or with S-thal. The mean RDWs in the latter two disorders were not significantly different. In SS patients, the RDW correlated significantly with the degree of anemia and reticulocytosis. A group of 18 SS patients was studied while in acute painful crisis. Their mean RDW was not different from that in the steady state. Mean WBC and red cell volume, however, were significantly higher during pain crisis.     

Red blood cell distribution width is associated with myocardial injury in non-ST-elevation acute coronary syndrome

OBJECTIVES:

The red blood cell distribution width has been associated with an increased risk of cardiovascular events. In the present study, we assessed the relationship between red cell distribution width values and cardiac troponin I levels in patients admitted with non-ST-elevation acute coronary syndrome.

METHODS:

We analyzed blood parameters in 251 adult patients who were consecutively admitted to the intensive coronary care unit with non-ST-elevation acute coronary syndrome over a 1-year period. For all patients, a baseline blood sample was collected for routine hematological testing. Cardiac troponin I was measured at baseline and after 6 h. The patients were diagnosed with non-ST-elevation myocardial infarction or unstable angina based on the elevation of cardiac troponin I levels.

RESULTS:

The red cell distribution width was higher in the group with non-ST-elevation myocardial infarction compared with the patient group with unstable angina (14.6±1.0 vs 13.06±1.7, respectively; p = 0.006). Coronary thrombus was detected more frequently in the group of patients with non-ST-elevation myocardial infarction than in the patients with unstable angina (72% vs 51%, respectively; p = 0.007). Using receiver operating characteristic curve analysis for the prediction of non-ST-elevation myocardial infarction based on the red cell distribution width, the area under the curve was 0.649 (95% confidence interval: 0.546-0.753; p = 0.006), suggesting a modest model for the prediction of non-ST-elevation myocardial infarction using the red cell distribution width. At a cut-off value of 14%, the sensitivity and specificity of the red cell distribution width were 73% and 59%, respectively. Additionally, the red cell distribution width was positively correlated with cardiac troponin I (r = 0.19; p = 0.006).

CONCLUSION:

A greater baseline red cell distribution width value was associated with myocardial injury and elevated cardiac troponin I levels in non-ST-elevation acute coronary syndrome. Therefore, the red cell distribution width could be considered for risk stratification of acute coronary syndrome patients admitted to emergency departments.     

Red blood cell volume distribution width (RDW) in uraemic patients on chronic haemodialysis

Red blood cell volume distribution width (RDW) was obtained with the Coulter counter in 60 haemodialysis patients and 55 normal individuals. RDW tended to be higher in the former and the degree of increase was to some extent correlated with the underlying nephropathy. Although RDW failed to correlate with conventional tests of iron status, it was observed that iron administration could produce a decrease toward normal in RDW and a parallel increase in haemoglobin when the initial RDW was increased. In contrast, the response to iron was negligible in the patients with normal RDW basally. It was concluded that high RDW is an acceptable indicator of iron deficiency in haemodialysis patients.     

Comparison of hemoglobin and red blood cell distribution width in the differential diagnosis of microcytic anemia.

In a total group of 415 subjects (100 normal controls, 115 with iron deficiency anemia, 100 with the alpha-thalassemia trait, and 100 with the beta-thalassemia trait), the following indexes were analyzed: hemoglobin distribution width, red blood cell distribution width (RDW)-coefficient of variation, and RDW-SD. The hemoglobin distribution width and RDW-coefficient of variation were examined with a laser light scattering system (Technicon H1), whereas the RDW-SD was determined with an impedance autoanalyzer (Sysmex M-2000). All of these parameters helped, to some extent, in the differential diagnosis of microcytic anemia. However, our data suggested a low RDW-SD might provide significantly more value in differentiating thalassemia traits from iron deficiency anemia, as well as from normal controls, while the hemoglobin distribution width gave no help in the differential diagnosis between iron deficiency anemia and the beta-thalassemia trait.     

Red blood cell zinc protoporphyrin to evaluate anemia risk in deferred blood donors

A large proportion of potential blood donors who are deferred are inappropriate to be donors because of unreliable predonation anemia screening methods. In this study, venous hemoglobin concentrations were within acceptable limits in 71% of 275 anemia deferrals. Red blood cell zinc protoporphyrin (RBC ZP) was evaluated as a screening test to improve the accuracy of detecting anemia in prospective blood donors. The frequency of abnormally low venous hemoglobin concentrations in anemia deferrals having fingerstick capillary microhematocrit (MH) values within 3% of the minimum requirement, together with normal RBC ZP levels (less than 53 micrograms/dL [0.943 mumol/L] RBC), was 2%, and not significantly different from the prevalence of venous anemia observed in eligible blood donors. Anemia deferrals with elevated RBC ZP results had a significantly increased rate of iron depletion and anemia. Capillary RBC ZP measurements in combination with the MH test have the potential to safely decrease inappropriate anemia deferrals.     

ABO血型不合异基因造血干细胞移植后继发纯红细再生障碍性贫血研究进展

 同种异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）是目前治愈多种恶性肿瘤、先天遗传性疾病和自身免疫性疾病的重要手段。ABO血型和HLA抗原在遗传上是独立的，20%～40% 的异基因造血干细胞供受者之间存在ABO血型不合^[1-4]。ABO血型不合分为主要不合（受者血浆含有抗供者红细胞的凝集素）、次要不合（供者血浆含有抗受者红细胞的凝集素）及主次均不合。供受者ABO血型不合不影响粒系、巨核系的植活，对移植物抗宿主病（GVHD）发生率及长期生存率等也没有影响，但是可以造成红系造血延迟，重者可发生纯红细胞再生障碍性贫血（PRCA），主要表现为粒细胞（≥ 0.5×109/L）和血小板（≥ 20×109/L）植活后，网织红细胞比例低于1%，同时骨髓增生良好而红系前体细胞缺如^{[1, 3, 5]}。国外学者[^{3, 6]}报道ABO血型主要不合allo-HSCT 患者 PRCA 的发生率为15%～20%，黄晓军等[2]报道的发生率为12%。目前无关供者allo-HSCT的开展使供受者ABO血型不合比例增加，加之非清髓性预处理方案的广泛应用，将使其发生率有所增高。相关问题如新型GVHD预防药物的应用是否对 PRCA发生产生影响，PRCA 治疗时机及最佳治疗方案等等，目前尚不明确，因此，ABO 血型不合问题在移植领域值得进一步研究。本文就相关研究进展做一综述。......     

红细胞体积分布宽度与心血管疾病的研究进展

红细胞体积分布宽度(red blood cell distribution width,RDW)是血液系统疾病鉴别诊断的经典指标。近年来越来越多的研究发现RDW与心血管疾病的发生、诊断和预后密切相关。本文对近年来有关RDW与心力衰竭、急性心肌梗死等心血管疾病的研究进行简要综述。     

Red blood cell distribution width as an easily measurable biomarker of persistent inflammation and T cell dysregulation in antiretrovirally treated HIV-infected adults

Background: Chronic inflammation and immune dysfunction occur in human immunodeficiency virus (HIV)-infection despite stable antiretroviral therapy (ART). Red blood cell distribution width (RDW) has been shown to correlate with markers of inflammation in non-HIV conditions. The study objective was to determine associations between RDW with cellular markers of immune activation and immune dysfunction including soluble inflammatory mediators in ART treated HIV infection.

Methods: We performed a cross-sectional analysis of the Hawaii Aging with HIV-Cardiovascular study. RDW was defined as one standard deviation of RBC size divided by mean corpuscular volume multiplied by 100%. Correlations were analyzed between RDW, soluble inflammatory biomarkers and T cell activation (CD38?+?HLA-DR+), senescence (CD28-CD57+), and immune exhaustion (PD-1, TIGIT, TIM-3 expression).

Results: Of 158 participants analyzed, median age was 50 years, duration of ART 12.6 years, virally suppressed 84.4%, and CD4 count 503 cells/mm3. Significant positive correlations were identified between RDW and soluble biomarkers including sICAM, IL-8, IL-6, SAA, TNF-α, sE-selection, fibrinogen, D-dimer, CRP, CD4/CD8 ratio, and frequency of multiple CD8 T-cell populations such as CD38?+?HLA-DR?+?T-cells, single TIGIT+, and dual expressing of TIGIT?+?PD1+, TIGIT?+?TIM3+, and TIM3?+?PD1+ CD8+ T-cell subsets (p?Conclusion: Our study revealed correlations between RDW with systemic inflammatory biomarkers and CD8+ T-cell populations related to immune activation and exhaustion in HIV-infected individuals on ART. Further studies are warranted to determine the utility of RDW as a marker of immune dysregulation in HIV.     

妊娠中晚期重度贫血患者红细胞分布宽度水平与心衰发生的相关性分析

目的:分析妊娠中晚期重度贫血患者红细胞分布宽度(Red blood cell distribution width,RDW)水平与心衰发生的相关性.方法:回顾性分析我院2018年12月至2019年12月收治的135例妊娠中晚期重度贫血患者临床资料,根据是否发生心衰分为心衰组(n=60)及非心衰组(n=75),另选取同期...     

Red blood cell distribution width as a simple negative prognostic factor in patients with diffuse large B-cell lymphoma: a retrospective study

AimTo determine the prognostic value of baseline red blood cell distribution width (RDW) in diffuse large B cell lymphoma (DLBCL) patients.MethodsData from 81 DLBCL patients diagnosed from 2006 to 2013 at the University Hospital Center Osijek, Osijek, Croatia, were reviewed. We evaluated disease outcome, overall survival (OS) and event-free survival (EFS), and demographic, clinical and laboratory factors affecting outcome. Univariate analysis and Cox regression analysis were used.ResultsMedian age of patients was 64 years, 29 were men (35.8%). Higher RDW levels (%) were found in patients with advanced Ann Arbor clinical stage (14.94 ± 1.82 vs 13.55 ± 1.54, P = 0.001) and in those with poor response to therapy (14.94 ± 1.82 vs 13.55 ± 1.54, P = 0.001). Patients with RDW>15% (cut-off was calculated by receiver operating characteristics) had significantly worse OS (median [range], 33 months [20-46] vs 74 months [65-82], P < 0.001) and EFS (27 months [15-40] vs 68 months [59-77], P < 0.001). Cox regression analysis showed that RDW>15% was an independent prognostic factor for OS (HR 3.654, 95% CI 1.128-11.836) and EFS (HR 2.611, 95% CI 1.012-6-739).ConclusionHigh baseline RDW is an independent prognostic marker of poor outcome in patients with DLBCL. RDW could be an easily available and inexpensive marker for the risk stratification in patients with DLBCL.Red cell distribution width (RDW) is analyzed routinely as part of the complete blood count (CBC). It is a measure of heterogeneity of the red blood cell (RBC) size and traditionally has played a role in the differential diagnosis of anemia (1). High RDW values are associated with increased mortality in general population and in patients with cardiovascular disease, sepsis, acute kidney injury, chronic obstructive pulmonary disease, hepatitis B, and those on chronic dialysis (2-9). There is also evidence of its prognostic value in various malignancies (10-14). A recent study found a strong relation between high RDW and poor survival in patients with lung cancer (15). RDW was also found to be a significant predictor of poor prognosis in patients with malignant mesothelioma (16). In patients with symptomatic multiple myeloma, elevated RDW values were associated with a higher stage disease according to International Staging System and poor prognosis (17). The mechanism that could explain the relation between RDW and survival or disease activity is not clear, but it is considered that high RDW is caused by chronic inflammation, poor nutritional status, oxidative stress, and age-related diseases that lead to changes in erythropoiesis (2,18-20).Diffuse large B-cell lymphoma (DLBCL) is the most common group of lymphomas, amounting to 25% of all non-Hodgkin’s lymphomas (NHL) (21). It is a type of aggressive lymphoma that usually affects middle-aged and elderly patients. The distribution of NHL subtypes in Croatia corresponds to the European average (22). The most commonly used prognostic index in aggressive NHL is the international prognostic index (IPI) and its variants used in elderly patients (age-adjusted IPI) and in patients treated with rituximab (R-IPI) (23,24).So far, there have been no reports on the prognostic value of RDW in patients with DLBCL. The aim of our study was to determine whether RDW measured at diagnosis was an independent prognostic factor of disease outcome, overall survival (OS), and event-free survival (EFS) in patients with DLBCL.     

Limitations of red blood cell distribution width (RDW) in evaluation of microcytosis

The red blood cell distribution width (RDW) has been proposed as an additional variable that would improve the initial classification of anemia. Microcytic anemias with an elevated RDW (greater heterogeneity) were used to distinguish iron deficiency from heterozygous thalassemia, which was said to have a normal RDW (more homogeneous). The authors attempted to classify their population of microcytic cases using the RDW as a major variable, but found only limited utility. While most of the iron-deficient cases had an increased RDW, almost one-half of the thalassemia cases also were classified as microcytic heterogeneous (increased RDW). The authors also found that target cells, erythrocytosis, and the ratios alone or in combination with the RDW were not specific in separating heterozygous thalassemia from iron deficiency. They conclude that a sequential evaluation (to include iron and hemoglobin studies) of cases of microcytosis is still needed.     

Red blood cell distribution width as a prognostic marker of mortality in patients on chronic dialysis: a single center,prospective longitudinal study

Aim

To determine if red cell distribution width (RDW) is associated with all-cause mortality in patients on chronic dialysis and to evaluate its prognostic value among validated prognostic biomarkers.

Methods

This is a single center, prospective longitudinal study. At the time of inclusion in January 2011, all patients were physically examined and a routine blood analysis was performed. A sera sample was preserved for determination of NT-pro-brain natriuretic peptide (NT-pro-BNP) and eosinophil cationic protein. Carotid intima media thickness (IMT) was also measured. Following one year, all-cause mortality was evaluated.

Results

Of 100 patients, 25 patients died during the follow-up period of one-year. Patients who died had significantly higher median [range] RDW levels (16.7% [14.3-19.5] vs 15.5% [13.2-19.7], P < 0.001. They had significantly higher Eastern Cooperative Oncology Group (ECOG) performance status (4 [2-4] vs 2 [1-4], P < 0.001), increased intima-media thickness (IMT) (0.71 [0.47-1.25] vs 0.63 [0.31-1.55], P = 0.011), increased NT-pro-BNP levels (8300 [1108-35000] vs 4837 [413-35000], P = 0.043), and increased C-reactive protein (CRP) levels (11.6 [1.3-154.2] vs 4.9 [0.4-92.9], P < 0.001). For each 1% point increase in RDW level as a continuous variable, one-year all cause mortality risk was increased by 54% in univariate Cox proportional hazard analysis. In the final model, when RDW was entered as a categorical variable, mortality risk was significantly increased (hazard ratio, 5.15, 95% confidence interval, 2.33 to 11.36) and patients with RDW levels above 15.75% had significantly shorter survival time (Log rank P < 0.001) than others.

Conclusions

RDW could be an additive predictor for all-cause mortality in patients on chronic dialysis. Furthermore, RDW combined with sound clinical judgment improves identification of patients who are at increased risk compared to RDW alone.In patients on chronic dialysis, the prevalence of cardiovascular disease is very high, and among patients with chronic renal failure atherosclerosis and cardiovascular diseases are the leading cause of morbidity and mortality (1,2). Recent investigations of atherosclerosis have focused on inflammation, emphasizing the importance of endothelial dysfunction and inflammatory biomarkers interaction, suggesting that a biomarker such as C-reactive protein plays a key role in promoting atherosclerosis process and endothelial cell activation and inflammation (3,4). C-reactive protein and NT-pro-brain natriuretic peptide (NT-pro-BNP) are strong and validated prognostic biomarkers, which are considered as gold standard in patient risk assessment and survival analysis (5). Also, recent studies have identified eosinophilic cationic protein (ECP) as a biomarker of coronary atherosclerosis (6). It has been stated that ECP serum concentration is proportional to the growth of atherosclerotic plaque in the coronary vessels (6).Several studies have identified red blood cell distribution width (RDW) as a strong and independent predictor of morbidity and mortality in general population (7,8), as well in different groups of patients with morbidities such as acute or chronic heart failure, cardiac arrest, pulmonary embolism, acute coronary syndrome, and even community acquired pneumonia (9-13). Furthermore, RDW has been identified as independent short- and long-term prognostic marker in intensive care unit patients, which significantly improves risk stratification of simplified acute physiology score (SAPS) (14). It is defined as a measure of variability in size of circulation erythrocytes and has traditionally played a role in the differential diagnosis of anemia (10). In everyday clinical practice, it is an automatically measured index, which is calculated by dividing standard deviation (SD) of red blood cells volume by mean corpuscular volume (MCV) and multiplying by 100 to express the results as percentage (10,15). Recently, it has been demonstrated that RDW could be an additive predictor for all-cause mortality in patients with acute renal failure treated with continuous renal replacement therapy (16). However, there are no data among patients with chronic renal failure treated with maintenance dialysis. Therefore, we aimed to investigate whether RDW was associated with all-cause mortality in patients on chronic dialysis and whether it would provide meaningful prognostic value among validated prognostic biomarkers.     

Red blood cell proteomics

Since its discovery in the 17th century, the red blood cell, recognized in time as the critical cell component for survival, has been the focus of much attention. Its unique role in gas exchange (oxygen/CO₂ transport) and its distinct characteristics (absence of nucleus; biconcave cell shape) together with an – in essence – unlimited supply lead to extensive targeted biochemical, molecular and structural studies. A quick PubMed query with the word “erythrocyte” results in 198 013 scientific articles of which 162 are red blood cell proteomics studies, indicating that this new technique has been only recently applied to the red blood cell and related fields. Standard and comparative proteomics have been widely used to study different blood components. A growing body of proteomics literature has since developed, which deals with the characterization of red blood cells in health and disease. The possibility offered by proteomics to obtain a global snapshot of the whole red blood cell protein make-up, has provided unique insights to many fields including transfusion medicine, anaemia studies, intra-red blood cell parasite biology and translational research. While the contribution of proteomics is beyond doubt, a full red blood cell understanding will ultimately require, in addition to proteomics, lipidomics, glycomics, interactomics and study of post-translational modifications. In this review we will briefly discuss the methodology and limitations of proteomics, the contribution it made to the understanding of the erythrocyte and the advances in red blood cell-related fields brought about by comparative proteomics.