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

Abstract

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 beta-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 cell-thalassaemia, 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.

Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia: a meta-analysis

“…Some investigators included also subjects with other types of hemoglobinopathy, like HbE [116,117,125], HbOArab [126] and HbS, both sickle cell thalassemia and sickle cell disease [48,94]. Unfortunately the numbers reported are too small for making a solid conclusion as to the utility of the discriminant indices in these conditions.…”

“…For example, Mentzer originally published his index with 13 as the cut-off value [3]. Other authors, however, used values between 13 and 14 [20,39,48,62,70], between 14 and 15 [7,34,38,43,55,58,59,65,82,87,93,94,96,101], 15.5 [57], 17 [44,61,92] or even as high as 20 [102], without proper validation. Therefore the effect of a modified cut-off value on an index's performance is difficult to judge and may require further investigations.…”

The Association between Red Cell Distribution Width and Mortality in Pediatric Acute Lymphoblastic Leukemia

“…Its normal range is between 11.5% to 14.5%. Elevated RDW on complete blood count reflects impairment in erythropoiesis and abnormal red blood cell survival which can be caused by any disease involving red blood cell destruction or production [1]. In recent years, several studies have demonstrated that elevation of this simple parameter is associated with increased risk of mortality in different contexts including sepsis, cardiovascular disease, cancer, and chronic lower respiratory tract disease [2][3][4][5][6][7][8][9][10].…”

Importance of RDW value in differential diagnosis of hypochrome anemias

“…Increased RDW value indicates anisocytosis, and hence, in addition to iron de®ciency anemia (IDA), it could be observed in hemolytic anemias including non-transfused b thalassemia major [3]. The d-b thalassemia trait (db-TT) is characterized by elevation of Hb F, a normal or decreased level of Hb A 2 , and red cell indices similar to those of b-TT.…”