红细胞分布宽度在小细胞低色素性贫血中的意义

目的探讨红细胞分布宽度（RDW）-CV和RDWS-D之间结果的关系,以明确RDW-SD的临床应用价值。方法先依据美国临床实验室标准化协会（CLSI）C28-A2指南建立二者的参考区间,分析二者的人群分布曲线,然后对121份随机临床标本、109例地中海贫血标本和25例缺铁性贫血标本同时测定RDW-CV和RDWS-D,并根据参考区间对二者的升高、降低情况进行比较分析。结果RDW-CV在正常人群中接近正态分布,RDWS-D呈偏态分布。RDW-CV和RDW-SD之间的升高或降低并不一致,RDW-CV增高或正常的标本其RDWS-D均可出现增高、正常或降低,RDW-CV降低的标本其RDW-SD也可出现正常或降低,二者在随机患者中符合率为80.0%。缺铁性贫血患者的RDW-CV和RDW-SD平均值均比地中海贫血的高（P〈0.001）,但地中海贫血患者间2个参数的分布范围均比缺铁性贫血患者间的分布范围宽,并把缺铁性贫血的分布范围包含其中。地中海贫血和缺铁性贫血患者的RDW-CV结果大部分均升高,小部分在正常范围。地中海贫血的RDW-SD结果可升高、正常或降低,并以降低为主,和RDW-CV呈“倒挂”现象,而缺铁性贫血患者未见降低者。结论联合检测RDW-CV和RDW-SD能更全面地反映RBC的异质性,并对地中海贫血和缺铁性贫血的鉴别诊断有一定的作用。

Significance on the red blood cell distribution width in microcytosis and hypochromia anaemia

Objective To study the relationship of red blood cell distribution width（RDW）-CV and RDW-SD,and know the clinical application value of RDW-SD.Methods The reference intervals of RDW-CV and RDW-SD were established firstly according to the Clinical and Laboratory Standards Institute（CLSI） Document C28-A2,and the distributions among healthy subjects were analyzed.The RDW-CV and RDW-SD of 121 random samples,109 samples from thalassanemia patients and 25 samples from iron deficiency anaemia patients were determined and analyzed according to the reference intervals.Results The distribution of RDW-CV in healthy subjects nearly conformed to normal distribution,and that of RDW-SD was skewed distribution.The trend of increasing or decreasing were not the same in RDW-CV and RDW-SD.When the samples′RDW-CV increased or were normal,their RDW-SD could increase,be normal or decrease.When the samples′ RDW-CV decreased,their RDW-SD could be normal or decrease.Their accordance was 80.0% in random samples.The averages of RDW-CV and RDW-SD in iron deficiency anaemia patients were higher than those in thalassanemia patients,but the ranges of RDW-CV and RDW-SD in thalassanemia patients were wider than those in iron deficiency anaemia patients,and included the distribution of iron deficiency anaemia patients.Most of the RDW-CV results of thalassanemia patients and iron deficiency anaemia patients were higher than the reference interval upper limit,and none showed lower than the reference interval lower limit.The RDW-SD in thalassanemia patients could usually decrease or increase and be normal,which was inverse to the RDW-CV,and none decreased among iron deficiency anaemia patients.Conclusions It can reflect the heterogeneity of red blood cell more roundly by determining the RDW-CV and RDW-SD simultaneously,which has significant value in the diagnosis of thalassanemia and iron deficiency anaemia.