BackgroundRed cell distribution width (RDW), a classical parameter used in the differential diagnosis of anemia, has recently been recognized as a marker of chronic inflammation and high levels of oxidative stress (OS). Fanconi anemia (FA) is a genetic disorder associated to redox imbalance and dysfunctional response to OS. Clinically, it is characterized by progressive bone marrow failure, which remains the primary cause of morbidity and mortality. Macrocytosis and increased fetal hemoglobin, two indicators of bone marrow stress erythropoiesis, are generally the first hematological manifestations to appear in FA. However, the significance of RDW and its possible relation to stress erythropoiesis have never been explored in FA. In the present study we analyzed routine complete blood counts from 34 FA patients and evaluated RDW, correlating with the hematological parameters most consistently associated with the FA phenotype.ResultsWe showed, for the first time, that RDW is significantly increased in FA. We also showed that increased RDW is correlated with thrombocytopenia, neutropenia and, most importantly, highly correlated with anemia. Analyzing sequential hemograms from 3 FA patients with different clinical outcomes, during 10 years follow-up, we confirmed a consistent association between increased RDW and decreased hemoglobin, which supports the postulated importance of RDW in the evaluation of hematological disease progression.ConclusionsThis study shows, for the first time, that RDW is significantly increased in FA, and this increment is correlated with neutropenia, thrombocytopenia, and highly correlated with anemia. According to the present results, it is suggested that increased RDW can be a novel marker of stress erythropoiesis in FA.Electronic supplementary materialThe online version of this article (doi:10.1186/s13023-016-0485-0) contains supplementary material, which is available to authorized users.

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Psychological stress can be viewed as occurring when demands exceed an individual's adaptive capacity. Burnout is an occupational syndrome defined by three dimensions, emotional exhaustion, depersonalization and feelings of low personal accomplishment. Factors related to the nature of the physiotherapy practice, in which health care is provided to patients under painful experiences and chronical conditions, to aspects related to emotional fatigue brought by interpersonal exchanges or physical exhaustion due to staff shortage, within an increasingly demanding health care system, expose physiotherapists to a higher risk of burnout and few studies have examined burnout in this specific setting.  Therefore, the aim of the present study was to assess the prevalence of burnout in Portuguese physiotherapists and to explore possible associations between burnout and demographic and work-related variables. Significant but weak association was found between age and emotional exhaustion, and between clinical experience and emotional exhaustion and global burnout score. Weak association was also found between the number of treated patients daily and daily working hours and physical fatigue and global burnout. Workload was associated with significantly higher scores of physical fatigue, cognitive weariness and global burnout. The prevalence of burnout was not high but significant differences were found in the prevalence of physical fatigue between the group with low workload and high workload. Emotional exhaustion was the most relevant predictor of the global burnout score. In conclusion, the results suggest that the prevalence of burnout in Portuguese physiotherapists is not very high, however, workload seems to place these professionals at a higher risk of developing burnout.