Association of erythrocyte deformability with red blood cell distribution width in metabolic diseases and thalassemia trait

Abstract

Increased red blood distribution width (RDW) in anemia is related to disturbances in the cellular surface/volume ratio, usually accompanied by morphological alterations, while it has been shown in inflammatory diseases that the activity of pro-inflammatory cytokines disturbing erythropoiesis increases RDW. Recently it has been reported that higher RDW is related with decreased erythrocyte deformability, and that it could be related with the association of RDW and increased risk of cardiovascular diseases. In order to analyze the influence of morphological alterations and proinflammatory status on the relationship between RDW and erythrocyte deformability, we analyzed erythrocyte deformability along with RDW and other hematological and biochemical parameters in 36 α-thalassemia, 20 β-thalassemia, 20 δβ-thalassemia trait carriers, 61 metabolic syndrome patients and 76 morbidly obese patients. RDW correlated inversely with erythrocyte deformability in minor β-thalassemia (r =-0.530, p < 0.05), and directly in both metabolic syndrome and morbidly obese patients (ρ= 0.270, p < 0.05 and ρ= 0.258, p < 0.05, respectively). Minor β-thalassemia is often accompanied by more marked cell-shaped perturbations than other thalassemia traits. This could be the reason for this negative association only in this setting. Higher anisocytosis seems to be associated with greater morphologic alterations (shape/volume), which reduce erythrocyte deformability. The proinflammatory profile in metabolic patients can be related to the positive association of RDW with erythrocyte deformability found in these patients. However, further research is needed to explain the mechanisms underlying this association.

An experimental erythrocyte rigidity index (Ri) and its correlations with Transcranial Doppler velocities (TAMMV), Gosling Pulsatility Index PI, hematocrit, hemoglobin concentration and red cell distribution width (RDW)

“…As observed in other studies [43], RDW correlates negatively with Hb and Hct. The greater the anemia, the higher the RDW value, as already observed in previous studies [43,86]. Correlations of the Rigidity index (Ri) with the velocities (TAMMV) in all the arteries are positive (see Fig 9).…”

Red cell distribution width is associated with albuminuria in adults with familial Mediterranean fever

“…Red cell distribution width (RDW) is a simple and inexpensive marker used very often in clinical practice; it is used to assess the changes of red blood cell size in complete blood count. RDW is often used as a guide for differential diagnosis with respect to thalassemia trait in anemia [10,11]. Additionally, existence of systemic inflammation may cause an increase in RDW.…”

Medical significance of simultaneous application of red blood cell distribution width (RDW) and neopterin as diagnostic/prognostic biomarkers in clinical practice

“…Oxidative stress may play a potential role in ischemic diseases with elevated RDW, as ischemic stroke, myocardial infarction, etc. [19,39]. Oxidative stress is a pathological factor which directly injures RBC plasma membranes, which affects their survival leading to RBC senescence and shortened erythrocyte life [28,40,41].…”

“…Recently, some studies reported that elevated (above 14%) RDW values are significantly related to decreased erythrocyte deformability [13,14,[17][18][19][20]. In the biorheological and hemorheological laboratories, RBC deformability is measured by means of a microfluidic slit-flow ektacytometer and expressed as erythrocyte elongation index (EI): patients with elevated RDW showed lower EI, than controls.…”

“…Recently, a large number of retrospective (and a few prospective) studies on the usefulness of RDW as an independent biomarker in the risk stratification and prevention of different socially important diseases in humans have been involved in the medical literature and clinical practice [3,[12][13][14][15][16][17][18][19][20][21][22][23]. Many studies have reported that the increased levels of RDW are closely associated with inflammation [24][25][26][27] and oxidative stress [28].…”