Red blood cell distribution width: A simple parameter with multiple clinical applications

Abstract

The red blood cell distribution width (RDW) is a simple and inexpensive parameter, which reflects the degree of heterogeneity of erythrocyte volume (conventionally known as anisocytosis), and is traditionally used in laboratory hematology for differential diagnosis of anemias. Nonetheless, recent evidence attests that anisocytosis is commonplace in human disorders such as cardiovascular disease, venous thromboembolism, cancer, diabetes, community-acquired pneumonia, chronic obstructive pulmonary disease, liver and kidney failure, as well as in other acute or chronic conditions. Despite some demographic and analytical issues related to the routine assessment that may impair its clinical usefulness, an increased RDW has a high negative predictive value for diagnosing a variety of disorders, but also conveys important information for short- and long-term prognosis. Even more importantly, the value of RDW is now being regarded as a strong and independent risk factor for death in the general population. Although it has not been definitely established whether an increased value of RDW is a risk factor or should only be considered an epiphenomenon of an underlying biological and metabolic imbalance, it seems reasonable to suggest that the assessment of this parameter should be broadened far beyond the differential diagnosis of anemias. An increased RDW mirrors a profound deregulation of erythrocyte homeostasis involving both impaired erythropoiesis and abnormal red blood cell survival, which may be attributed to a variety of underlying metabolic abnormalities such as shortening of telomere length, oxidative stress, inflammation, poor nutritional status, dyslipidemia, hypertension, erythrocyte fragmentation and alteration of erythropoietin function. As such, the aim of this article is to provide general information about RDW and its routine assessment, to review the most relevant implications in health and disease and give some insights about its potential clinical applications.

Red cell distribution width, other hematological parameters and atherogenic index of plasma in patients with clopidogrel and aspirin resistance

“…There are a number of studies indicating that RDW has been influenced by inflammation and oxidative stress, and a strong correlation between RDW and inflammatory markers, C-reactive protein, and sedimentation rate has been observed [11][12][13]. We found that inflammation-related CBC parameters were similar between the groups; however, this was not in agreement with our working hypothesis.…”

Red cell distribution width and cancer

“…In the last years, a number of studies have demonstrated that this simple parameter, automatically reported by laboratory blood analyzers, may have multiple clinical applications: an increased RDW has a high negative predictive value (NPV) for diagnosing a variety of disorders and may be useful to evaluate short-and long-term prognosis in cardiovascular and thrombotic disorders (4)(5)(6). C o n s i d e r a b l e a t t e n t i o n h a s b e e n p a i d f o r t h e observation that RDW is a strong predictor of all-cause, cardiovascular-and cancer-related mortality in the general population ( Table 1).…”

The Acute Effect of the Antioxidant Drug U-74389G on Red Blood Cell Distribution Width Levels During Hypoxia Reoxygenation Injury in Rats

“…Salvagno GL et al 18 describe red blood cell distribution width (RDW) as a simple and inexpensive parameter, which refl ects the degree of heterogeneity of erythrocyte volume (conventionally known as anisocytosis); which is traditionally used in laboratory hematology for differential diagnosis of anemias. Nonetheless, recent evidence attests that anisocytosis is commonplace in human disorders such as cardiovascular disease, venous thromboembolism, cancer, diabetes, community-acquired pneumonia, chronic obstructive pulmonary disease, liver and kidney failure, as well as in other acute or chronic conditions.…”