Red Cell Distribution Width Index Research Articles

Optimizing the Diagnosis of Microcytic Hypochromic Anemia: A Comparative Evaluation of Erythrocyte and Reticulocyte Parameters.

Background Anemia is a widespread, worldwide hematological disorder, with iron deficiency anemia (IDA) and thalassemia trait (TT) being two frequently encountered forms. For effective management, it is vital to distinguish between these two conditions. Existing diagnostic methods have some limitations due to their inaccessibility and high cost. This study aims to evaluate novel hematological indices for distinguishing IDA from TT, offering potential improvements in diagnostic accuracy and patient care. Objective To compare the efficacy of novel hematological indices in differentiating IDA from TT, and to assess their sensitivity and specificity in clinical practice. Methods This cross-sectional observational study included 80 anemia patients (40 diagnosed cases of IDA and 40 of TT each). Hematological parameters were measured using the Sysmex XN-1000 analyzer (Sysmex Corporation, Kobe, Japan), and statistical analysis was conducted using the Mann-Whitney test, Pearson correlation coefficient (r), and correlation matrix. Results Significant differences were observed between IDA and TT patients in the indices studied. The Green and King Index demonstrated high diagnostic accuracy, with a sensitivity of 90% and specificity of 82%. The red cell distribution width (RDW) Index exhibited similar diagnostic performance, with a sensitivity of 90% and specificity of 77%. The England and Fraser Index showed a sensitivity of 85% and specificity of 80%, with a large effect size (r = -0.60). The correlation matrix revealed strong associations between key parameters, including a negative correlation between hemoglobin and RDWIndex (r = -0.61) and a positive correlation between mean corpuscular volume (MCV) and Shine and Lal Index (r = 0.82). On the other hand, our study found that indices like Shine and Lal and Srivastava had limited diagnostic value, with smaller effect sizes (r = 0.28 and r = -0.005, respectively). Conclusion Hematological indices, such as the Green and King, RDW, and England and Fraser indices, show strong potential for differentiating IDA from TT, with high sensitivity, specificity, and large effect sizes. The correlation matrix further supports the diagnostic utility of these indices. These tools can enhance diagnostic precision in resource-limited settings and improve patient outcomes.

Red cell Distribution Width index as prognostic marker of the course and outcome of pleural empyema developing after pneumonia: a prospective cohort study

Red cell Distribution Width index as prognostic marker of the course and outcome of pleural empyema developing after pneumonia: a prospective cohort study

Association between red cell distribution width and all-cause mortality in patients with breast cancer: A retrospective analysis using MIMIC-IV 2.0.

Investigating the association between red cell distribution width (RDW) and all-cause mortality in patients with breast cancer, to evaluate the potential clinical prognostic value of RDW. Based on the RDW index, patients with breast cancer in the Medical Information Mart for Intensive Care (MIMIC-IV) database were categorized into quartiles. The primary outcomes included in-hospital mortality from all causes during the first six months, the first year, and the first three years. Cox hazards regression and restricted cubic spline (RCS) models were developed to investigate the effects of RDW on primary outcomes. The study included 939 patients (female). The 6-month, 1-year, and 3-year mortality rates were 14.0%, 21.4%, and 28.4%, respectively. Multivariate Cox proportional hazards analyses demonstrated that RDW exhibited an autonomous association with an increased risk of all-cause mortality. After adjusting for confounders, higher RDW quartiles were significantly associated with 6-month mortality (adjusted hazard ratio (HR), 3.197; 95% confidence interval (CI), 1.745-5.762; P < 0.001), 1-year mortality (adjusted HR, 2.978; 95% CI, 1.867-4.748; P < 0.001), and 3-year mortality (adjusted HR, 2.526; 95% CI, 1.701-3.750; P < 0.001). The RCS curves demonstrated that high RDW (> 14.6) was associated with a greater risk of all-cause mortality. Subgroup analyses revealed no statistically significant differences in the interactions between the subgroups. The study revealed a highly pronounced relationship between RDW and overall mortality, indicating its potential as an autonomous prognostic factor for increased mortality among patients with breast cancer.

Validity of Erythrocyte Indices in Differentiation between Iron Deficiency Anemia and β-Thalassemia Trait in Children

Iron deficiency anemia (IDA) and β-thalassemia trait (BTT) are the most common causes of hypochromic microcytic anemia (HMA). Various erythrocyte indices that may help in the initial discrimination between IDA and BTT have been reported, but data evaluating their reliability in children are scarce. We aimed to evaluate the validity of 12 erythrocyte indices in the differentiation between IDA and BTT in children. These indices were red blood cell (RBC) count, Mentzer Index, England and Fraser Index, Srivastava Index, Shine and Lal Index, RBC distribution width (RDW), Ricerca Index, Green and King Index, RDW Index, Sirdah Index, Ehsani Index, and Serdar Index. Among 1,444 children with HMA, 136 (9.4%) were stratified into the IDA group and 137 (9.5%) into the BTT group. Of the 12 indices, the Green and King Index showed the highest reliability, as it had the highest Youden’s index (75.1%). Its sensitivity, specificity, positive predictive value, negative predictive value and correct diagnosis rate were 92.7%, 82.4%, 84.1%, 91.8% and 87.5%, respectively. The second most reliable index was the RDW Index, having a Youden’s index, sensitivity, specificity, positive predictive value, negative predictive value and correct diagnosis rate of 64.0%, 94.2%, 69.9%, 75.9%, 92.2% and 82.0%, respectively. Receiver operating characteristic analysis showed that the revised cut-off values for the Green and King Index and RDW Index had higher sensitivity and specificity levels than the cut-off values commonly used in the literature. The findings of this study suggest the superiority of the Green and King Index and the RDW Index as screening tools in the initial differentiation between IDA and BTT among children with HMA.

Associations of Increased Red Cell Distribution Width Levels with the Severity of Carotid Artery Stenosis: Cross-sectional Study Results.

Red blood cell distribution width (RDW) is being actively studied as a biomarker in various cardiovascular diseases (CVDs). The aim of this study was to conduct a comparative analysis of RDW in patients with carotid atherosclerosis, comparing it with an assessment of the severity of carotid artery stenosis (CAS). The Duplex registry database was used to conduct this retrospective cross-sectional study. The study participants underwent a complete blood count test, analysis for lipid profile, and carotid ultrasound. The patients were divided into 5 groups depending on CAS degree: none; 20%-49%; 50%-69%; 70%-99%; and occlusion. Data from 2548 patients were included in the final analysis (mean age: 57.9 ± 12.3 years; 51% males [n = 1301]). The analysis confirmed the relationship between the increase in the RDW index and CAS gradation increase in men (Kr-W H = 16.43; P = 0.0009), but was not confirmed in women (Kr-W H = 4.32; P = 0.22). Significantly higher levels of high-density lipoprotein cholesterol and platelets and lower levels of red blood cell and white blood cells were registered in female patients without CAS and with CAS < 50% compared with men (P < 0.001). The results of the present study showed that RDW is an indicator whose increase is associated with an increase in the degree of carotid atherosclerosis in men, but not in women. This allows to discuss the role of the RDW index as a possible new laboratory biomarker of inflammation and progression of atherosclerosis, which can make an additional contribution to the formation of increased morbidity and mortality in men from atherosclerotic CVD.

Diagnostic Value of Red Cell Distribution Width and Red Blood Cell Distribution Width Index in Differentiating between Iron Deficiency Anemia and Beta Thalassemia Trait

Objective: To determine the diagnostic value of red blood cell distribution width and red cell distribution width index in differentiating iron deficiency anaemia and beta-thalassemia trait. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2021 to Feb 2022. Methodology: A study population of 110 children with an age limit of 1.5-7 years who reported low haemoglobin wassubjected to serum iron and ferritin levels with further evaluation of red cell count, blood morphology, and comparison of mean corpuscular volume. Red cell distribution width was taken from the lab report, whereas Red blood cell distribution width index value was computed for the samples. Results: A total of 110 patients were enrolled in the study. Seventy-five (68.18%) participants were diagnosed with IDA, 26(23.63%) participants were the candidate of βTT. Nine participants were suffering from anaemia of variable etiologies such as chronic ailment and sideroblastic, etc. βTT patients presented with higher RBC counts with a mean of 5.71±1.2 x1012 /l (6.8- 8.5 x1012 /l) when compared to IDA participants who deciphered values of 3.5±0.5 (2.6-4.3 x1012 /l). Mean MCV in βTT was 52.2±2.7(50.1-56.8) whereas for IDA were 72.5±1.2(61.2–78.3). In IDA low serum ferritin was recorded 4.02±1.1(2.2-9.2) as compared to mean values of βTT patients. Conclusion: Red cell distribution width index and Red blood cell distribution width are authentic variables and inexpensive modalities in differentiating between iron deficiency anaemia and beta-thalassemia trait with reliability.

Red Cell Distribution Width Association with Subclinical Cardiovascular Disease in Patients with Rheumatoid Arthritis.

Red cell distribution width (RDW) is a measure of the variation in mean corpuscular volume that reflects the degree of anisocytosis on the peripheral blood smear. RDW value variation has been implicated in several disorders including chronic inflammatory processes and cardiovascular (CV) diseases. In the present work, our objective was to study the relationship that RDW has with the characteristics of the disease in patients with rheumatoid arthritis (RA), focusing on CV risk factors and subclinical atherosclerosis. A cross-sectional study was conducted that included 430 patients with RA and 208 controls matched by sex and age. Complete blood count, including RDW, was assessed. Multivariable analysis was performed to analyze the relationship of RDW with RA disease characteristics, subclinical carotid atherosclerosis, and traditional CV factors, including a comprehensive profile of lipid molecules and insulin resistance and beta cell function indices. After multivariable adjustment, the RDW was significantly higher in RA patients compared with controls (beta coefficient 1.0 [95% confidence interval 0.2 to 1.8] %, p = 0.020). Furthermore, although the erythrocyte sedimentation rate showed a positive and significant relationship with RDW, this association was not found with C-reactive protein and interleukin-6. A positive and independent relationship was observed between DAS28-ESR disease activity score and RDW. However, no association was found between the RDW and other disease activity scores that do not include erythrocyte sedimentation rate in their formula. The SCORE2 CV risk algorithm was positively and significantly associated with higher RDW values. Likewise, a negative relationship was found between RDW with total cholesterol and low-density lipoprotein cholesterol, and a positive relationship was found between RDW and insulin resistance indices. In conclusion, RDW values are higher in RA patients compared to matched controls. Although the relationship of RDW with disease activity was not consistent, RDW shows associations with subclinical CV disease risk factors, including dyslipidemia and insulin resistance, and with the SCORE2 CV disease-risk prediction algorithm.

A-145 Development of a Novel Algorithm Using Red Blood Cell Indices for Screening of Alpha Globin Gene Deletions

Abstract Background Distinguishing between different causes of microcytic anemia is essential for management of anemic patients. More than 20 different RBC indices have been used to screen thalassemia trait with inconsistent results. Differentiation between iron deficiency anemia (IDA) and alpha-thalassemia is challenging based on RBC indices alone. Moreover, thalassemia and IDA may coexist. A highly sensitive screening algorithm is needed to select clinical cases for alpha globin gene analysis to reduce unnecessary testing and improve pre-test probabilities. Methods A retrospective study was performed to evaluate the reliability of 22 RBC indices (RBC, MCV, RDW, MCH, Mentzer Index, RDW Index, etc) and formulae in differentiating cases with 1–2 alpha globin gene deletions from negative cases, in a cohort of 90 individuals with confirmatory alpha globin gene analysis results. Results The number of patients with each alpha globin gene deletion pattern were: 37 patients with alpha-thalassemia trait, 21 silent carriers (one gene deletion), 31 patients with negative result and 1 patient with triplicated alpha globin gene. The mean RBC count in each group were 4.79 ± 0.65 (trait), 4.45 ± 0.73 (carrier), and 4.21 ± 0.84 (negative) (million/mm). The mean MCV in each group were 71.1 ± 4.8 (trait), 76.1 ± 5.9 (carrier), and 74.2 ± 9.3 (negative) (fL). The mean RDW in each group were 16.5 ± 3.0 (trait), 17.2 ± 3.4 (carrier), and 18.3 ± 4.9 (negative) (%). The mean MCH in each group were 22.0 ± 1.8 (trait), 23.8 ± 2.3 (carrier), and 23.5 ± 3.7 (negative) (pg). None of the RBC indices showed significant difference between carrier and negative groups, while 20 RBC indices showed significant difference (P &amp;lt; 0.05) between trait and negative groups. The sensitivities of the RBC indices in detecting 1–2 alpha globin gene deletions based on published cut-offs ranged between 3.4% and 81.0%, while the specificities ranged between 41.9% and 100%. A novel scoring algorithm was evaluated based on the combination of 12 selected RBC indices and formulae, with each index or formula contributing to a score of 0 or 1. The average value of the negative cases was used as the score cut-off value for each index or formula. The scoring algorithm gave a score distribution between 0 and 12, with lower scores indicating alpha globin gene deletions. It achieved a sensitivity of 96.6% in detecting 1–2 alpha globin gene deletions, with a negative likelihood ratio of 0.15. The negative likelihood ratio of the scoring algorithm outperformed each of the individual RBC indices at similar levels of sensitivities (&amp;gt;95%). Conclusion The novel algorithm is a highly sensitive tool for screening of alpha globin gene deletions, including one gene deletion. It is more effective at identifying negative cases compared to individual RBC indices. Implementation of the algorithm could efficiently reduce 10.0% (9/90) of the test volume of alpha globin gene analysis. A more stringent version of the algorithm that incorporates standard deviation in the cut-off values could potentially achieve nearly 100% sensitivity and reduce 5.6% (5/90) of the alpha globin gene analysis test volume.

Utility of red blood cell parameters and indices of iron homeostasis in evaluation of microcytosis without anemia or with mild anemia: a diagnostic accuracy study

Introduction: Asymptomatic microcytosis may be a prelude to microcytic hypochromic anemia of varied causes. Evaluation of red cell indices may help delineate cases needing further investigation like hemoglobin high-performance liquid chromatography (Hb-HPLC). In addition, markers of iron homeostasis will help confirm iron-deficient erythropoiesis (IDE)/iron deficiency anemia (IDA). Materials and Methods: This was a single institutional hospital-based study over a period of 18 months. The sample size was 60, which include all age groups, males and females, and values of mean corpuscular volume (MCV) &lt; 80 fL, Hb ≥ 10g/dL were taken as the inclusion criteria. Various derived red cell indices, Hb-HPLC, and iron parameters were assessed. HbHPLC and serum ferritin with transferrin saturation (TSAT) values were taken as the gold standard for diagnosis of hemoglobinopathies/thalassemia trait and IDA/IDE, respectively. Statistical Analysis: Mean with standard deviation was calculated for normally distributed data such as Hb, RBC count, RDW, MCV, MCH, MCHC, and hematocrit. Median with range was calculated for non-normally distributed data. Results: Out of 60 samples, 24 (40%) and 36 (60%) had abnormal and normal proportion of Hb variants, respectively. In total, seven indices were evaluated, which included Mentzer’s index, red cell distribution width index, Ehsani’s index, Sirdah’s formula, Matos–Carvalho index, Shine and Lal index, and Sehgal’s index. The Shine and Lal index showed better sensitivity (89%) and specificity (73%) for diagnosing pure thalassemia trait. The Sirdah index showed better sensitivity (78%) and specificity (42%) in diagnosing IDE/IDA. Ferritin showed better sensitivity (74%) and specificity (84%) in diagnosing pure IDA and TSAT showed better results in diagnosing IDA/IDE. Conclusion: The Shine and Lal index and Mentzer index can be used as screening tools and help detect subjects who require appropriate follow-up with confirmation by HbHPLC. Serum ferritin remains the gold standard for diagnosis of IDA.

Most Reliable Haematological Indices for Diagnosis of Iron Deficiency Anaemia from Non-Iron Deficiency Anaemia in Reproductive-Age Females

Iron deficiency anaemia has become a major public health issue, especially in women of reproductive age. About 50% of anaemia is caused by iron deficiency anaemia. Numerous statistical procedures based on red blood cell parameters have been developed to easily, quickly, and inexpensively provide a differential diagnosis for the microcytic anaemia. The study aims to evaluate the reliability of the haematological discrimination indices (RBC count, Mentzer index, Red blood cell distribution width index (RDWI), Srivastava index, Green and King index, and Ehsani index) to distinguish iron deficiency anaemia from other causes of the microcytic anaemia. The blood samples were collected from non-pregnant women, and they had the microcytic anaemia. During the study, 101 blood samples were taken. A Complete blood count test and serum ferritin test were performed to calculation of the sensitivity, specificity, positive, and negative predictive value for each discrimination indices. The validity of discrimination indices was evaluated by using Youden's index. In correctly distinguishing iron deficiency anaemia from other causes of the microcytic anaemia, the Green and King index and RBC count showed the highest ability (77%) and (76%), respectively. None of the discrimination indices had 100% sensitivity or specificity. The highest and lowest sensitivity were found for the RBC count and RDWI, at 92% and 70%, respectively. The RDWI had the highest level of specificity (65%), and the Srivastava index had the lowest level of specificity (30%). The highest positive predictive value found for both Green and King, and RDWI was 78%, and the RBC count had the highest negative predictive value (78%). The Srivastava index had the lowest levels of positive and negative predictive values, 67% and 50%, respectively. According to the findings of this study, the most reliable index in the calculation of Youden's index is the Green and King index. It can be used as a pre-diagnostic tool for IDA and other causes of the microcytic anaemia

Evaluation of the RDW Index (Red Cell Distribution Width) in Women with Breast Cancer Treated with Doxorubicin in a One-Year Follow-Up Study.

Breast cancer is the most common cancer and the most frequent cause of death in women. Doxorubicin, an anthracycline, is an important drug due to its efficacy in treating solid cancers, especially breast cancer. However, this drug is often responsible for cardiotoxicity that may affect more than 25% of patients. This study aimed to evaluate the red cell distribution width (RDW) in women with breast cancer to monitor adverse events associated with the use of doxorubicin. A prospective study of 80 women with breast malignancy undergoing neoadjuvant doxorubicin-based chemotherapy was conducted. The patients were evaluated at baseline (T0), just after the last cycle of chemotherapy with doxorubicin (T1), and 1 year after the treatment (T2). There was a significant increase over the time points for the RDW (p < 0.001). There was a negative correlation between the RDW and C-reactive protein (CRP) levels at T1. The RDW did not show a significant difference between the groups classified according to cardiotoxicity. Based on these results, the RDW is a cost-effective test that shows a relationship with the doxorubicin response, but not with cardiotoxicity. It is a potential biomarker to evaluate patients with breast cancer after they receive chemotherapy with doxorubicin.

Mentzer and RDW Index in the Establishment of Iron Deficiency Anemia Diagnosis in the First Trimester of Pregnant Woman

Mentzer and RDW Index in the Establishment of Iron Deficiency Anemia Diagnosis in the First Trimester of Pregnant Woman

Red Cell Distribution Width and Platelet Indices in Women with Pre-eclampsia: A Cross-sectional Study

Introduction: To determine the prognosis and fetomaternal outcome in eclampsia and pre-eclampsia, a simple and costeffective approach is to assess the Red cell Distribution Width (RDW) and platelet count. RDW, Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and platelet markers such as Mean Platelet Volume (MPV) have been the subject of research. Aim: To compare the variation of RDW, NLR, PLR, and platelet indices between women with pre-eclampsia and gestational age-matched healthy controls. Materials and Methods: A cross-sectional study was conducted among 208 pregnant women (104 with pre-eclampsia and 104 controls) at the Department of Obstetrics and Gynaecology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India, from January 2020 to June 2021. RDW, NLR, PLR, and platelet indices were analysed after obtaining detailed history, conducting clinical examinations, and relevant investigations. An Independent t-test was used as a test of significance to identify the mean difference between the two quantitative variables. Results: The RDW among cases was 17.05±4.01, whereas among controls, it was 15.09±1.86. The mean age of subjects among case group was 25.72±4.741 years, while in the control group it was 23.25±3.803 years. There was a significant difference in mean Red cell Distribution Width- Coefficient of Variation (RDW-CV) between the two groups. The MPV among cases was 9.86±1.14, while among controls, it was 8.92±1.40 (p-value=0.001). The PDW among cases was 11.30±2.20, and among controls, it was 12.72±3.50. The mean NLR among cases was 5.92±4.94, whereas among controls, it was 4.59±2.22. There was a significant difference in mean platelet count, MPV, PDW, and NLR between the two groups. Conclusion: According to the findings of the current study, RDW, NLR, and MPV were all shown to be higher in women with pre-eclampsia. Additionally, pre-eclamptic women consistently exhibited decreased PDW and platelet counts.

Development of a Novel Algorithm Using Red Blood Cell Indices for Screening of Alpha Globin Gene Deletions

Abstract Distinguishing between different causes of microcytic anemia is essential for management of anemic patients. More than 20 different RBC indices have been used to screen thalassemia trait with inconsistent results. Differentiation between iron deficiency anemia (IDA) and alpha-thalassemia appears to be more challenging than differentiation between IDA and beta-thalassemia, based on RBC indices alone. Moreover, thalassemia and IDA may coexist. A highly sensitive screening algorithm is needed to select clinical cases for alpha globin gene analysis to reduce unnecessary testing and improve pre-test probabilities. A retrospective study was performed to evaluate the reliability of 22 RBC indices (RBC, MCV, RDW, MCH, Mentzer Index, RDW Index, etc) and formulae in differentiating cases with 1-2 alpha globin gene deletions from negative cases, in a cohort of 90 individuals with confirmatory alpha globin gene analysis results. The number of patients with each alpha globin gene deletion pattern were: 37 patients with alpha-thalassemia trait, 21 silent carriers (one gene deletion), 31 negative patients and 1 patient with triplicated alpha globin gene. The mean RBC count in each group were 4.79 +/- 0.65 (trait), 4.45 +/- 0.73 (carrier), and 4.21 +/- 0.84 (negative) (million/mm). The mean MCV in each group were 71.1 +/- 4.8 (trait), 76.1 +/- 5.9 (carrier), and 74.2 +/- 9.3 (negative) (fl). The mean RDW in each group were 16.5 +/- 3.0 (trait), 17.2 +/- 3.4 (carrier), and 18.3 +/- 4.9 (negative) (%). The mean MCH in each group were 22.0 +/- 1.8 (trait), 23.8 +/- 2.3 (carrier), and 23.5 +/- 3.7 (negative) (pg). None of the RBC indices showed significant difference between carrier and negative groups, while 20 RBC indices showed significant difference (p&amp;lt;0.05) between trait and negative groups. The sensitivities of the RBC indices in detecting 1-2 alpha globin gene deletions based on published cutoffs ranged between 3.4% and 81.0%, while the specificities ranged between 41.9% and 100%. A novel scoring algorithm based on the combination of 12 RBC indices and formulae achieved a sensitivity of 96.6% in detecting 1-2 alpha globin gene deletions, with a negative likelihood ratio of 0.15. The negative likelihood ratio of the scoring algorithm outperformed each of the 12 RBC indices at similar levels of sensitivities (&amp;gt;95%) based on revised cutoffs. The algorithm is a highly sensitive tool for screening of alpha globin gene deletions, including one gene deletion. It is more effective at identifying negative cases compared to individual RBC indices. Implementation of the algorithm could efficiently reduce 10.0% (9/90) of the test volume of alpha globin gene analysis. A more stringent version of the algorithm could achieve 100% sensitivity and reduce 5.6% (5/90) of the alpha globin gene analysis test volume.

The effect of SGLT-2i administration on red blood cell distribution width in patients with heart failure and type 2 diabetes mellitus: A randomized study.

BackgroundRecent studies suggest that the pivotal mechanism of sodium glucose co-transporter-2 inhibitors (SGLT-2i) favorable action in patients with heart failure (HF) and type 2 diabetes mellitus (DM) is the stimulation of erythropoiesis via an early increase in erythropoietin (EPO) production which leads to hematocrit rise. Red blood cell distribution width (RDW) is a simple hematological parameter which reflects the heterogeneity of the red blood cell size (anisocytosis). Since, EPO has been also implicated in the pathophysiology of RDW increase, the current mechanistic study examined the effect of SGLT-2i administration on red blood cells size (RDW) in patients with HF and DM.MethodsThe present was a prospective single-center study. Patients (N=110) were randomly assigned to dapagliflozin (10 mg a day on top of antidiabetic treatment) or the control group. Inclusion criteria were: (a) age > 18 years, (b) history of type 2 DM and hospitalization for HF exacerbation within 6 months. The evaluation of patients (at baseline, 6 and 12 months) included clinical assessment, laboratory blood tests, and echocardiography. Data were modeled using mixed linear models with dependent variable the RDW index. In order to find factors independently associated with prognosis (1-year death or HF rehospitalization), multiple logistic regression was conducted with death or HF rehospitalization as dependent variable.ResultsAn RDW increase both after 6 and after 12 months was observed in the SGLT-2i (dapagliflozin) group (p < 0.001 for all time comparisons), whereas RDW didn't change significantly in the control group. The increase in RDW was positively correlated with EPO, while negatively correlated with ferritin and folic acid (p < 0.005 for all). Baseline RDW was significantly associated with 1-year death or rehospitalization, after adjusting for group (SGLT-2i vs. control), age, gender, smoking and BMI at baseline.ConclusionRDW increased with time in patients with HF and DM who received SGLT-2i (dapagliflozin). The increased RDW rates in these patients may stem from the induction of hemopoiesis from dapagliflozin. Baseline RDW was found to be independently associated with outcome in patients with HF and DM.

Evaluation of Srivastava index to distinguishing Beta-Thalassemia Trait from Iron Deficiency

Objective: To assist in the differential diagnosis of beta thalassemia trait and iron deficiency anaemia, many alternative red blood cell index-based formulae were examined. Methods: The Rawalpindi PEMH performed this study from June 2021 to March 2022. For individuals with beta- thalassemia trait and iron deficient anaemia, age and gender were not considered. More than five millilitres of blood were drawn from each patient in order to determine the haemoglobin content, the number of red blood cells, how they were distributed, and the average cell volume. Five alternative formulas may be used to differentiate these two circumstances. Shine and Lal index, Mentzer index, Srivastava index and Green &amp; King index are among the most well- known ones. Youden's index was included in the calculation of sensitivity, specificity, and positive and negative predictive values (PPVs). Results: The iron deficiency anaemia rate was 70%, and the beta thalassemia phenotype was 30% among the 1500 participants. This indicator has a sensitivity of 100% and specificity of 93.3% when it comes to discriminating between beta-thalassemia trait and iron deficiency anaemia. Conclusion: The red cell distribution width index may be used to differentiate between beta thalassemia trait and iron deficiency anaemia. If a haemoglobin electrophoresis is not available, a diagnosis of beta thalassemia may still be made. Keywords: Srivastava index, beta-thalassemia, Anemia, Cell redness, Hb electrophoresis

Use of Red Cell Distribution Width Index for Screening and Differentiation of Iron Deficiency Anemia and Beta Thalassemia Trait

Background: Iron deficiency anemia (IDA) is one of the common nutritional disorders in the world. In the subcontinent Microcytic hypochromic anemia is usually caused by beta thalassemia trait (BTT) and iron deficiency anemia (IDA). IDA may be confused with BTT. It is important to distinguish between the above conditions to avoid unnecessary iron therapy in thalassemia carriers. Red cell distribution width index (RDWI) are a simple, easy, and cost effective method to get a primary and valuable information regarding the diagnosis of IDA and BTT. Objective: To assess the predictive value of Red cell distribution width index (RDWI)) for differentiation of Iron Deficiency Anaemia and Beta Thalassaemia Trait.Material &amp; Methods:The study was a cross-sectional descriptive study which was conducted in Department of Clinical Pathology, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh. Over a period of April 2019 to September 2020. The newly clinically diagnosed cases of BTT and IDA were selected for this study. The sample size was 110. Among them 46 cases were identified as BTT and 64 were IDA. Data were analysed using a computer programme SPSS 25.0 version.Results:Total 110 respondents were included in the study. Among them 46.4% were female and 53.6% were male. About 72.72 % of respondents were aged 1 to 10 years old, while 10% were aged 11 to 20 years old and 10% were aged 21 to 30 years old. 4.54 % were between the ages of 31 to 40, as well as those over 40. The average age (SD) was 22.0 ± 32.52. Mean (±SD) age was 22.0 ± 32.52. RDWI had both sensitivity and specificity more than 80% in detection of BTT and IDA. Sensitivity, specificity of RDWI index for detection of BTT was found 81.0%, 83.8%. In case of IDA, sensitivity and specificity was found 83.8% and 81.0% respectively.Conclusions:The current study found that multiple discriminants can be used to differentiate between iron deficiency anemia and the Beta Thalassaemia Trait. RDWI could be a better way to tell the difference between BTT and IDA.

Status of Red Blood Cell Indices in Iron Deficiency Anemia and β Thalassaemia Trait: A Comparative Study

Background: Iron deficiency anemia (IDA) and b thalassemia trait (b -TT) are the two important differential diagnosis of microcytic hypochromic anaemia. It is important to distinguish between the above two conditions to avoid unnecessary iron therapy. Red blood cell (RBCs) indices are simple, easy, and cost effective method to get a primary and valuable information regarding the diagnosis of IDA and b -TT.&#x0D; Objectives: This study was aimed to compare the RBC count, hemoglobin (Hb), hematocrit (Hct%), RBC indices, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW) and redcell distribution width index (RDWI) in Iron deficiency anemia and b thalassemia trait.&#x0D; Methods: This cross-sectional comparative study was conducted in the department of clinical pathology, Dhaka Shishu Hospital, Dhaka from July 2019 to March 2020. Total 107 patients with microcytic hypochromic anaemia (64 subjects of IDA and 43 subjects of b -TT were tested for RBC count, Hb%, MCV, MCH, MCHC, RDW, and PCV from venous blood by haematology analyser. Serum ferritin was measured by Enzyme Linked Immunosorbent Assays (ELISA). Statistical analysis was performed by SPSS version 22. Statistical significance was set at p value less than 0.05.&#x0D; Results: RBC count, Hb, and Hct,MCV, MCH and MCHC were significantly lower and RDW and RDWI was significantly higher in IDA group than in b- TT group (p&lt; 0.001). Similar result was observed in male and female participants when compared them in separate group.&#x0D; Conclusion: The study showed that RBC count, Hb, Hct, MCV, MCH, and MCHC were significantly lower in IDA group than in b-TT group, whereas RDW and RDWI were significantly higher in IDA group than in b-TT group.&#x0D; DS (Child) H J 2021; 37(1): 9-14

Clinical value of blood related indexes in the diagnosis of bacterial infectious pneumonia in children

BackgroundThis study sought to explore the value of hematological indexes [i.e., the neutrophil count/lymphocyte count ratio (NLR), the platelet count/lymphocyte count ratio (PLR), and red cell distribution width (RDW) index] in the diagnosis of bacterial infectious pneumonia in children.MethodsFifty cases of mycoplasma infectious pneumonia, 50 cases of bacterial infectious pneumonia and 50 healthy children were enrolled in this study. The differences between the NLR, PLR, and RDW index values in each group were compared using the Mann-Whitney test. The correlation coefficients of the NLR, PLR, and RDW index with the interleukin-6 (IL-6) and procalcitonin (PCT) were analyzed using the Spearman’s rank test. The specificity and sensitivity of the NLR, PLR, and RDW index in the diagnosis of bacterial pneumonia in children were evaluated by receiver operating characteristic (ROC) curves.ResultsThe NLR value of the children with bacterial infectious pneumonia was significantly higher than that of the children with mycoplasma infectious pneumonia (P<0.05) and healthy children (P<0.05), while the PLR value of the children with bacterial infectious pneumonia was significantly lower than that of the children with mycoplasma infectious pneumonia (P<0.05) and healthy children (P<0.05). There was no significant difference in the RDW index values of the healthy control children and the children with mycoplasma infectious pneumonia and bacterial infectious pneumonia (P>0.05). There was a positive correlation between NLR and serum IL-6 (R=0.203; P=0.041), and a negative correlation between PLR and serum PCT (R=–0.291; P=0.037). In addition, there was no significant correlation between the RDW index and serum IL-6, and the RDW index and serum PCT in children with bacterial infectious pneumonia. When the 3 indicators were each used to differentiate between healthy children and children with bacterial pneumonia, the area under the PLR curve was the largest for the ROC curve [0.898, 95% confidence interval (CI): 0.815–0.953]. In the differential diagnosis of mycoplasma pneumonia and bacterial pneumonia, the area under the PLR curve was also the largest (0.803, 95% CI: 0.577–0.780).ConclusionsThe PLR has clinical value in the diagnosis of bacterial infectious pneumonia in children.

Haematological Profile in Microcytic Hypochromic Anaemia in Children

INTRODUCTION: The most common disorders presenting with microcytic hypochromic anaemia are iron deficiency anaemia (IDA) and β-Thalassemia trait (β-TT), and each of them has different pathogenesis and treatment modality. Here we intend to see the haematological profile in microcytic hypochromic anaemia in children apart from IDA and Thalassemia with respect to age and gender. MATERIAL AND METHODS: A total of 95 pediatric patients between the ages of 2 to 12 years with microcytic hypochromic anaemia were included in the study. Blood samples obtained from each patient were evaluated for various haematological and biochemical profiles along with haemoglobin electrophoresis. It was a hospital based observational cross-sectional study done for a period of 18 months from January 2019 to July 2020. RESULTS: Severe anaemia was seen in 55 (57.89%) cases, followed by 38 (40.00%) cases with moderate anaemia and 2 (2.11%) cases with mild anaemia. Majority of the cases showed IDA, which were 85 (89.5%) cases, followed by 6 (6.3%) cases with β-TT and 4 (4.2%) cases with β-TM. RBC count, hematocrit and RDW showed significant variation between IDA, β-TM and β-TT. Most number of correctly diagnosed cases were shown by Ricerca Index with 90 (94.74 %). CONCLUSION: Our study concludes RBC count and RDW, along with Srivasthava Index, Ricerca Index and RDW Index could be used as reliable indices to differentiate between iron deficiency anaemia and β-Thalassemia. Red cell indices, serum iron profile and haemoglobin electrophoresis complement each other for the precise diagnosis of underlying cause of microcytic hypochromic anaemia.