幼年型类风湿关节炎患者RDW及MCV的分析

目的：研究幼年型类风湿关节炎(JRA)的红细胞体积分布宽度(RDW)和红细胞平均体积(MCV)的变化,以探讨幼年型类风湿关节炎的贫血的变化。方法：选用美国ABBOTT公司生产的CD-3000型全自动血液分析仪测定小儿的MCV和RDW。结果：JRA组MCV为(79.5476±6.9136)fl,RDW为(17.3905±3.1608)%,正常对照组MCV为(86.5133±3.5297)fl,RDW为(11.990±0.5313)%,两组比较差异有显著性意义(P<0.01)。结论：幼年型类风湿关节炎的贫血为小细胞不均一性,红细胞平均体积减少,体积分布宽度增大。     

单个网织红细胞血红蛋白量在诊断儿童缺铁性贫血中的意义

目的研究网织红细胞血红蛋白量(CHr)在诊断儿童缺铁性贫血(IDA)中的意义。方法 100例1～6岁IDA患儿和50例正常儿童(对照组)作为研究对象。采用血细胞分析仪检测CHr、Hb、RBC、平均红细胞容积(MCV)等红细胞参数;采用放射免疫双抗体法检测血清铁蛋白(SF);采用ELISA方法测定转铁蛋白受体(sTfR)。结果 IDA组的Hb和CHr分别为100±6 g/L和18±5 pg,低于对照组(126±8 g/L,31±3 pg;P<0.01)。IDA组的SF(11±4μg/L)低于对照组(59±36μg/L;P<0.01);sTfR则高于对照组(4.8±2.1 mg/L vs1.4±0.6 mg/L;P<0.01)。对照组、IDA组的CHr与Hb呈正相关(r分别为0.540,0.734,P<0.01);IDA组的CHr与SF呈正相关(r=0.464,P<0.01);IDA组的CHr与sTfR呈负相关(r=-0.450,P<0.01)。当CHr的临界值为27.8 pg时,诊断小儿IDA的敏感度和特异度分别为88.0%和90.0%,ROC曲线下面积为0.948。结论 CHr可以作为诊断儿童IDA的指标。     

早产儿红细胞体积分布宽度分析

红细胞体积分布宽度RDW在国外已是广泛用作贫血诊断及分类的一项指标，近年来国内外多项研究表明RDW是诊断缺铁性贫血的最早期重要指标。国内刘皖君教授等曾研究早产儿与足月儿骨髓铁储存异常，表明早产儿于生后第8周骨髓内已不能见到含铁血黄素，而足月儿骨髓铁储存到生后20-24周方耗尽，但早产儿骨髓铁储存异常的原因相关报道少见。笔者尝试从RDW方面探寻原因。     

外周血平均红细胞体积在诊断地中海贫血中的临床价值评价

为评价外周血平均红细胞体积 (MCV)在筛查和诊断地中海贫血 (地贫 )中的临床价值。对地贫患者及家属进行外周血常规普查及地贫相关检查 ,并对检验结果进行分析研究。结果 ,1、15 0个家系共计 467人中地贫患者 3 49例。地贫患者中MCV <78fl者 3 18例 ,占地贫总数的 91 12 % ;MCV >78fl者 3 1例 ,占 8 88%。 2、MCV>78fl的 3 1例地贫患者中 ,α地贫 2 1例 ,β地贫 9例 ,混合型地贫 1例 ,分别占66 7%、2 9 0 3 %和 3 2 3 %。基因分型多为静止型 ( -α αα)或突变型α地贫 ( 13 2 1,61 9% ) ;α地贫患者中MCV正常的发生率为 11 86% ;β地贫MCV正常的发生率为5 3 6%。结果表明 :MCV指标在临床筛查地贫中具有重要临床价值。但各型地贫 (特别是静止型α地贫 )中MCV可以正常。是临床及产前筛查过程中造成地贫基因携带者漏诊的主要原因。应引起临床医生的重视     

应用血液学指标诊断新生儿地中海贫血

目的　成人中应用血液学指标筛查地中海贫血的报道较多,但成人的血液学诊断值不能应用于新 生儿。本研究旨在评价红细胞平均体积(MCV)、红细胞脆性、红细胞体积分布宽度(RDW)对新生儿地中海贫血的 诊断价值。方法　以386例在本院新生儿科接受治疗的高未结合胆红素血症患儿为研究对象,根据地贫基因诊断 结果分为地贫组(n=35)和非地贫组(n=351)。检测患儿MCV、红细胞脆性、RDW等血液学指标,作出ROC曲 线,分别计算曲线下面积和各指标的最佳临界值以及相应的敏感度、特异度。结果　地贫组的MCV、RDW和脆性 分别是80±8fL、16.2%±1.0%、31%±13%,而非地贫组为94±9fL、15.8%±1.0%、46%±14%,其中两组 MCV和红细胞脆性的差别具有显著意义(均P<0.01)。在诊断地贫时,MCV的ROC曲线下面积(AUCROC)为 0.877,最佳临界值为88fL,该临界值的敏感度和特异度分别是92%和73.5%;红细胞脆性的AUCROC为0.796,最 佳临界值为37.5%,该临界值的敏感度和特异度分别是85%和75%;RDW的AUCROC为0.630,最佳临界值为 15.9%,该临界值的敏感度和特异度分别是73%和58%。结论　MCV和红细胞脆性均可作为新生儿地贫诊断的 有效指标,且MCV的诊断价值优于红细胞脆性。     

应用血液学指标诊断新生儿地中海贫血

目的　成人中应用血液学指标筛查地中海贫血的报道较多,但成人的血液学诊断值不能应用于新 生儿。本研究旨在评价红细胞平均体积(MCV)、红细胞脆性、红细胞体积分布宽度(RDW)对新生儿地中海贫血的 诊断价值。方法　以386例在本院新生儿科接受治疗的高未结合胆红素血症患儿为研究对象,根据地贫基因诊断 结果分为地贫组(n=35)和非地贫组(n=351)。检测患儿MCV、红细胞脆性、RDW等血液学指标,作出ROC曲 线,分别计算曲线下面积和各指标的最佳临界值以及相应的敏感度、特异度。结果　地贫组的MCV、RDW和脆性 分别是80±8fL、16.2%±1.0%、31%±13%,而非地贫组为94±9fL、15.8%±1.0%、46%±14%,其中两组 MCV和红细胞脆性的差别具有显著意义(均P<0.01)。在诊断地贫时,MCV的ROC曲线下面积(AUCROC)为 0.877,最佳临界值为88fL,该临界值的敏感度和特异度分别是92%和73.5%;红细胞脆性的AUCROC为0.796,最 佳临界值为37.5%,该临界值的敏感度和特异度分别是85%和75%;RDW的AUCROC为0.630,最佳临界值为 15.9%,该临界值的敏感度和特异度分别是73%和58%。结论　MCV和红细胞脆性均可作为新生儿地贫诊断的 有效指标,且MCV的诊断价值优于红细胞脆性。     

早期新生儿铁储备降低与孕妇缺铁的关系

近年来认为血清铁蛋白(SF)和红细胞内游离原卟啉(FEP)测定可反映机体早期隐性缺铁的情况。但有关新生儿期FEP的报道却很少见到。我们将105例早期健康新生儿进行了血红蛋白(Hb),红细胞计数(RBC)以及FEP的测定分析,从而了解新生儿铁储备与孕妇缺铁的关系。     

手工测尿红细胞平均体积鉴别血尿来源

本文对９０例血尿患者的尿红细胞平均体积用传统的方法进行了测定，肾小球性尿红细胞平均体积比非肾小球性尿红细胞和自身外周血红细胞体积小得多，统计学处理有高度显著性差异，而后两者相比差异无显著性。肾性患者血与尿红细胞平均体积差也具有诊断价值。认为此方法简便经济，特异性强，灵敏度高，适于基层医院推广。     

川崎病患儿外周血中红细胞和血小板参数的变化

川崎病（KD）是一种以全身血管炎为主要病理改变的急性发热、出诊性疾病：多数患儿还可以出现贫血、血小板数升高等改变。本文通过全自动血细胞计数仪对KD患儿的外周血红细胞和血小板参数的观察，发现其贫血患儿的平均红细胞体积（MCV）降低、红细胞分布宽度（RDW）增高，为小细胞不均一性贫血，符合缺铁性贫血的表现。KD患儿血小板数普遍较高，尤其病程早期的平均血小板体积（MPV）增高，提示有血小板增多的趋势和在血管炎性反应中的重要作用。因此，对KD患儿应尽早使用抗血小板药物，在治疗过程中注意对缺铁性贫血的纠正。     

3624名儿童预防剂量铁剂干预防治铁缺乏症的效果观察

采取铁营养灵敏指标SF、FEP、Hb对3624名学龄前儿童预防剂量铁剂干预前后观察，发现反映机体铁储备的SF与Hb呈明显正相关，与反映红细胞缺铁程度的FEP、FEP／Hb呈负相关，铁剂干预后SF、Hb明显升高，FEP、FEP／Hb有所下降。说明小剂量铁剂干预补充储备铁的不足是防治儿童铁缺乏症的重要措施。同时发现，儿童铁缺乏症患病率仍处于较高的水平，尤以6月～2岁儿童为最高，随年龄增长逐渐减少，经三个月铁剂干预，铁缺乏症患病率有所下降，6月～2岁儿童铁缺乏症患病率下降最明显。认为加强儿童期保健工作，降低儿童铁缺乏症患病率，尤其是高危年龄组的铁缺乏症患病率仍是儿童保健工作的重要任务。     

血常规指标对儿童铁缺乏的预测作用

目的探讨血常规指标在筛查儿童铁缺乏中的预测价值。方法回顾性分析2017年6月至2019年5月浙江大学医学院附属儿童医院1443名6月龄~18岁健康体检儿童(男862名、女581名)的血常规指标及血清铁蛋白(SF)水平。以SF<20μg/L为铁缺乏判断依据,同时伴有贫血(6月龄~5岁血红蛋白<110 g/L,6~18岁血红蛋白<120 g/L)为缺铁性贫血(IDA)组:SF<20μg/L同时排除贫血为无贫血铁缺乏组,SF≥20μg/L合并贫血者为铁状态不明贫血组,SF≥20μg/L无贫血者为健康对照组。定量资料以±s或M(四分位间距)描述,组间比较应用方差分析或非参数秩和检验分析,并应用受试者工作特征曲线(ROC)分析血常规指标及低血红蛋白密度百分比(LHD)对IDA及铁缺乏的预测价值。结果1443名儿童年龄2.1(3.3)岁,健康对照组1061例,无贫血铁缺乏组292例,铁状态不明贫血组43例,IDA组47例。铁缺乏发生率高于贫血发生率[23.5%(339/1443)比6.2%(90/1443),χ2=169.76,P<0.01]。无贫血铁缺乏组LHD、红细胞分布宽度(RDW)均高于健康对照组[0.088(0.093)比0.073(0.068),0.131±0.013比0.126±0.008,P均<0.01],平均红细胞体积(MCV)、平均血红蛋白浓度(MCHC)均低于健康对照组[(80±4)比(83±4)fl,(326±9)比(329±8)g/L,P均<0.01];IDA组LHD[0.322(0.544)]、RDW(0.151±0.018)均高于无贫血铁缺乏组,MCV[(73±6)fl]、MCHC[(309±14)g/L]均低于无贫血铁缺乏组(P均<0.01)。MCHC、LHD、RDW、MCV预测铁缺乏的曲线下面积(AUC)分别为0.63(95%CI:0.60~0.67)、0.63(95%CI:0.60~0.67)、0.67(95%CI:0.63~0.70)和0.73(95%CI:0.69~0.76)。以MCV<80.2 fl、RDW>0.131或MCHC<322 g/L为界值,筛查铁缺乏的灵敏度分别为0.540、0.469和0.336,均高于血红蛋白筛查铁缺乏的灵敏度(0.139,χ2=121.70、87.47、35.56,P均<0.01)。结论血常规中MCV、RDW、MCHC均可作为铁缺乏的筛查指标,简便易于基层推广。     

Red Cell Distribution Width in the Diagnosis of Iron Deficiency Anemia

Objective: 1. To compare peripheral smear (PS) and Red cell distribution width (RDW) in diagnosis of Iron deficiency anemia (IDA) in various grades. 2. To study the changes in RDW and PS after therapy.Methods : Children in the age group of six months to five years with microcytic (MCV < 80fl) anemia (Hemoglobin < 11g%) were evaluated. Those who had received blood transfusion and /or were already on iron therapy were excluded. Evaluation included clinical examination, complete blood count (CBC), RDW estimation microscopic examination of peripheral smear, measurement of serum iron and transferrin saturation. Children with IDA were treated with oral iron for 8 weeks and PS, CBC including RDW were repeated.Result: Of the 100 children evaluated, 89 had IDA. 48% had mild, 42% had moderate and 10% had severe anemia. Transferrin saturation correlated with severity of anemia. Peripheral smear showed microcytosis and hypochromia in all cases with severe anemia, 61.5% and 22.5% of those with moderate and mild anemia respectively. RDW was suggestive of iron deficiency in 100%, 82.05% and 100% of patient with mild, moderate and severe anemia respectively.Conclusion : In the diagnosis of mild and moderate iron deficiency anemia, RDW had a higher sensitivity than PS. Red cell morphology, Hb, PCV and RDW showed significant improvement after iron-therapy     

RDW参数与儿童缺铁关系的探讨

随着自动血细胞计数仪的普及应用，红细胞体积分布宽度（RDW）的测定已成为血液学检验的常规项目。许多学者认为RDW的异常提示缺铁性贫血IDA）的存在（1），并以此筛查儿童早期IDA。本文以红细胞内锌克卟啉（ZPP）含量为红细胞生成铁缺乏（IDE）的指标（2），观察RDW与缺铁的关系。对象及方法一、对象非贫血患儿156例，贫血组104例，均为本院门诊及住院儿科病人。二、方法1．RDW、Hb、MCV测定使用美国cell－－Dynl600型血细胞计数仪及配套试剂。2．ZPP测定使用西安2001型ZPP荧光仪，测定前须用质控片标准，操作按说明书。三、…     

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目的探讨网织红细胞平均血红蛋白质量在小儿缺铁性贫血中的诊断价值。方法采用拜耳ADVIA120全自动血液分析仪检测50名健康儿童和59例临床诊断为缺铁性贫血患儿的外周血细胞和网织红细胞血红蛋白质量,同时用BeckmanCx9测定血清铁蛋白质量浓度,将所得数据进行统计学分析。结果血红蛋白(Hb)、平均红细胞体积(MCV)、单个网织红细胞平均血红蛋白(CHr)质量、血清铁蛋白(SF)在缺铁性贫血患儿明显低于健康儿童,而平均红细胞体积分布宽度(RDW)在缺铁性贫血患儿明显高于健康儿童。结论CHr质量作为诊断儿童缺铁性贫血的指标,具有重要的临床价值。     

Red blood cell distribution width is not a reliable biomarker for low iron stores in children with cystic fibrosis

Low iron stores in children, absolute iron deficiency (AID), can lead to impaired neurodevelopment and requires iron therapy. In the presence of infection/inflammation, like in cystic fibrosis (CF), serum ferritin (SF) is not a reliable biomarker for AID. Red blood cell distribution width (RDW) is a promising alternative reported not to be influenced by infection in healthy children. Currently, there are no data on the diagnostic capacity of RDW to detect AID in pediatric CF patients. This was a prospective observational study that investigated iron status biomarkers in 53 Dutch pediatric CF patients. AID was defined using World Health Organization criteria for SF in stable patients (no recent pulmonary exacerbation) and C-reactive protein (CRP) ≤10 mg/l. Patients with AID had higher RDW levels than patients without AID (p = 0.019). An RDW ≥13.2% showed the following test statistics: sensitivity 100%; specificity 39.4%; positive predictive value 20%; and negative predictive value 100%. Furthermore, we found a correlation between RDW and CRP in the total group that originated from the stable patients (r = 0.308; p = 0.042). In conclusion, the diagnostic capacity of RDW for detecting AID in pediatric CF patients seems limited because RDW levels might also be influenced by chronic infection/inflammation in these patients.     

Red Blood Cell Distribution Width and the Platelet Count in Iron-deficient Children Aged 0.5–3 Years

Early detection of iron deficiency (ID) and iron deficiency anemia (IDA) in young children is important to prevent impaired neurodevelopment. Unfortunately, many biomarkers of ID are influenced by infection, thus limiting their usefulness. The aim of this study was to investigate the value of red blood cell distribution width (RDW) and the platelet count for detecting ID(A) among otherwise healthy children. A multicenter prospective observational study was conducted in the Netherlands to investigate the prevalence of ID(A) in 400 healthy children aged 0.5–3 years. ID was defined as serum ferritin (SF) <12 μg/L in the absence of infection (C-reactive protein [CRP] <5 mg/L) and IDA as hemoglobin <110 g/L combined with ID. RDW (%) and the platelet count were determined in the complete blood cell count. RDW was inversely correlated with SF and not associated with CRP. Calculated cutoff values for RDW to detect ID and IDA gave a relatively low sensitivity (53.1% and 57.1%, respectively) and specificity (64.7% and 69.9%, respectively). Anemic children with a RDW >14.3% had a 2.7 higher odds (95% confidence interval [CI]: 1.2–6.3) to be iron deficient, compared with anemic children with a RDW <14.3%. The platelet count showed a large range in both ID and non-ID children. In conclusion, RDW can be helpful for identifying ID as the cause of anemia in 0.5- to 3-year-old children, but not as primary biomarker of ID(A). RDW values are not influenced by the presence of infection. There appears to be no role for the platelet count in diagnosing ID(A) in this group of children.     

Diagnosing iron deficiency in cyanotic heart disease

Objective : To determine the incidence of iron deficiency in children with CCHD by noninvasive, inexpensive and easy laboratory methods.Methods : Forty four children with cyanotic congenital heart disease (CCHD), aged 6 to 48 months were included in this study. The patients were categorized as iron deficient (n:28) and iron sufficient group (n:16). Children with CCHD who had iron deficiency were treated with iron for 3 months.Result : Iron sufficient patients were followed during 3 months without giving iron preparation. Mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), red cell distribution width (RDW), serum iron (SI), total iron binding capacity (TIBC) and serum ferritin levels were measured in all patients at the beginning and at the end of the study.Conclusion : In children with CCHD, hemoglobin (Hb), hematocrit (Hct) and red blood cell (RBC) counts were not considered significant parameters in the diagnosis of iron deficiency. Determination of MCV, MCH, RDW values is relatively easy and inexpensive method requiring small amount of blood for the diagnosis of iron deficiency during the follow-up of patients with CCHD     

幽门螺杆菌感染对学龄前儿童铁营养状况的影响

目的 探讨Hp感染对儿童铁营养状况的影响。方法 对475名2-7岁儿童进行膳食和社会经济状况调查。外周血血细胞分析,血清铁蛋白及Hp抗体检测。对血清Hp抗体阳性者进行粪便Hp抗原测定和粪便潜血试验。结果 64名儿童感染Hp,305名儿童未感染,感染Hp儿童血清铁蛋白水平明显低于未感染Hp儿童。两组调整后的血清铁蛋白均值及95%可信区间分别为23.62μg/L（7.13μg/L-78.26μg/L）,33.48μg/L（10.28μg/L-109.06μg/L）。以非条件logistic多元回归模型有效平衡其他因素的混杂偏倚后,Hp感染仍是儿童铁缺乏的危险因素。其OR值为7.95(OR95%CI为2.56-24.67)。结论 Hp感染儿童机体铁营养水平降低。Hp感染是造成或加重儿童机体铁营养不良的独立危险因素。     

Evaluation of erythrocyte disorders with mean corpuscular volume (MCV) and red cell distribution width (RDW)

The red cell distribution width (RDW), which provides a quantitative measure of heterogeneity of red cells in the peripheral blood, and the mean corpuscular volume (MCV) are part of the routine red cell indices reported by automated blood analyses. This study evaluated 193 pediatric patients with a wide range of erythrocyte disorders and determined the diagnostic utility of the RDW in relation to the MCV. Six different groups of erythrocyte disorders by MCV and RDW values are described: low MCV/normal RDW, low MCV/high RDW, normal MCV/normal RDW, normal MCV/high RDW, high MCV/normal RDW, high MCV/high RDW. This combination established a useful differential diagnosis of erythrocyte disorders. The data provided a baseline against which future studies of infants and children can be compared, though each laboratory has to verify its own normals. It should be cautioned that different electronic counters yield different RDW values, so there have to be qualifications when reporting reference values. The RDW may find its best use as a guide in the differential diagnosis of anemia, rather than as a definitive test per se.     

The value of red cell distribution width in the diagnosis of anaemia in children

The red cell distribution width index (RDW) was determined in 103 normal children, 69 iron-deficient (ID) patients, 73 with the thalassaemia trait, and 71 with other haemoglobinopathies. Elevated RDW values were found in anaemic patients, the highest values in ID anaemia, sickle thalassaemia, sickle cell anaemia, and -thalassaemia trait in decreasing order. The normal RDW in children was 13.2±0.9 and an elevated RDW reflects active erythropoiesis. The RDW was elevated and the MCV low in all 69 patients with ID anaemia. The RDW was also elevated in 11/13 children with sickle cell anaemia, in 25/29 patients with sickle cellthalassaemia, and in all patients with thalassaemia major. The ID anaemia could be differentiated from the thalassaemia trait by the markedly elevated RDW in ID anaemia (mean= 20.7±3.2) and the mildly elevated RDW (mean 15.4±1.4) in thalassaemia trait. The RDW index discriminated better than Mentzer's index, discriminant function or the Shine Lal index. Thus the RDW is a good indicator of anisocytosis, and a good screening index especially for ID anaemia and the thalassaemia trait.Abbreviations CV coefficient of variation - DF discriminant function - EDTA ethylene diamine tetraacetic acid - Hb haemoglobin - ID iron deficiency - MCHC mean corpuscular haemoglobin concentration - MCV mean corpuscular volume - RBC red blood cell - RDW red cell distribution width - SD standard deviation