Abstract
Anisocytosis has been associated with the severity and prognosis of several acute and chronic diseases, as well as physiological conditions such as pregnancy. Anisocytosis is quantified by the red blood cell distribution width (RDW), expressed as the ratio, multiplied by 100, between the standard deviation (SD) of red blood cell volumes and the mean corpuscular volume, or as the SD of erythrocyte volumes (RDW-SD). The aim of the present review was to report the state of the art on the physiological values and the putative diagnostic and prognostic roles of RDW in complicated pregnancy. Literature research for articles published in the last ten years was conducted in Pubmed, Web of Science, ClinicalTrials.gov, and Scopus databases. s were independently screened by two investigators. If relevant, full articles were retrieved. References, in these articles, citing relevant reviews or original studies were also accessed to identify additional eligible studies. Any disagreement between the reviewers was resolved by a third investigator. A total of 28 studies were included in the review. These studies reported changes in RDW values during physiological pregnancy, and associations between the RDW and several pregnancy complications including anaemia, preeclampsia, gestational diabetes, and recurrent miscarriage. This review provides background information for establishing physiological and pathological RDW values in pregnancy for diagnostic and prognostic use in clinical practice.
Highlights
Anisocytosis, the alteration of the normal volume of red blood cells (RBC), is characterized by a high intrinsic plasticity of the external membrane and low haemoglobin content, which allow a certain degree of expansion or contraction in response to physiological or pathological stimuli [1]
Three articles reported red blood cell distribution width (RDW) values in physiological pregnancy, seven articles focused on anaemia, seven on preeclampsia, and eleven articles on other complications such as cholestasis, diabetes, pancreatitis, and ectopic pregnancy
Despite RDW has been introduced in clinical practice several decades ago, normal reference ranges in pregnancy are not well-established
Summary
Anisocytosis, the alteration of the normal volume of red blood cells (RBC), is characterized by a high intrinsic plasticity of the external membrane and low haemoglobin content, which allow a certain degree of expansion or contraction in response to physiological or pathological stimuli [1]. Anisocytosis is quantified by the red blood cell distribution width (RDW), expressed as the ratio between the standard deviation (SD) of RBC volumes and the mean corpuscular volume (MCV), multiplied by 100 (RDW-CV), or as the SD of erythrocyte volumes (RDW-SD). Red blood cell distribution width is useful in the differential diagnosis of anaemias and other pathological conditions that lead to anisocytosis. Several inexpensive and widely available haematological indexes including the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), and RDW have gained scientific interest because of their ability to reflect the systemic inflammatory state of the organism and have been associated with the severity and prognosis in several acute and chronic diseases, including cancer [3,4,5,6,7].
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