Red Blood Cell Distribution Width: A Novel Predictive Indicator for Cardiovascular and Cerebrovascular Diseases

Disease Markers, Sep 2017

The red blood cell distribution width (RDW) obtained from a standard complete blood count (CBC) is a convenient and inexpensive biochemical parameter representing the variability in size of circulating erythrocytes. Over the past few decades, RDW with mean corpuscular volume (MCV) has been used to identify quite a few hematological system diseases including iron-deficiency anemia and bone marrow dysfunction. In recent years, many clinical studies have proved that the alterations of RDW levels may be associated with the incidence and prognosis in many cardiovascular and cerebrovascular diseases (CVDs). Therefore, early detection and intervention in time of these vascular diseases is critical for delaying their progression. RDW as a new predictive marker and an independent risk factor plays a significant role in assessing the severity and progression of CVDs. However, the mechanisms of the association between RDW and the prognosis of CVDs remain unclear. In this review, we will provide an overview of the representative literatures concerning hypothetical and potential epidemiological associations between RDW and CVDs and discuss the underlying mechanisms.

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Red Blood Cell Distribution Width: A Novel Predictive Indicator for Cardiovascular and Cerebrovascular Diseases

Red Blood Cell Distribution Width: A Novel Predictive Indicator for Cardiovascular and Cerebrovascular Diseases Ning Li,1,2,3 Heng Zhou,1,2,3 and Qizhu Tang1,2,3 1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China 2Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China 3Hubei Key Laboratory of Cardiology, Wuhan 430060, China Correspondence should be addressed to Qizhu Tang; nc.ude.uhw@gnatzq Received 17 June 2017; Revised 17 July 2017; Accepted 25 July 2017; Published 6 September 2017 Academic Editor: Fabrizia Bamonti Copyright © 2017 Ning Li et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract The red blood cell distribution width (RDW) obtained from a standard complete blood count (CBC) is a convenient and inexpensive biochemical parameter representing the variability in size of circulating erythrocytes. Over the past few decades, RDW with mean corpuscular volume (MCV) has been used to identify quite a few hematological system diseases including iron-deficiency anemia and bone marrow dysfunction. In recent years, many clinical studies have proved that the alterations of RDW levels may be associated with the incidence and prognosis in many cardiovascular and cerebrovascular diseases (CVDs). Therefore, early detection and intervention in time of these vascular diseases is critical for delaying their progression. RDW as a new predictive marker and an independent risk factor plays a significant role in assessing the severity and progression of CVDs. However, the mechanisms of the association between RDW and the prognosis of CVDs remain unclear. In this review, we will provide an overview of the representative literatures concerning hypothetical and potential epidemiological associations between RDW and CVDs and discuss the underlying mechanisms. 1. Introduction Cardiovascular and cerebrovascular diseases (CVDs) are the general terms for all heart and cerebrum diseases related to vasculopathy, which mainly include heart failure (HF), atherosclerosis, myocardial infarction (MI), arrhythmia, hypertension, and stroke [1]. Although medications and devices have been improved in recent years, mortality and morbidity in patients with CVDs remain high in recent years. CVDs continue to be the most common cause of death globally, rather than cancer and communicable diseases [2, 3]. The accurate risk assessment and stratification as well as prognosis evaluation for patients with CVDs, especially high-risk populations, are critical to cardiologists and neurologists. Current diagnosis of CVDs mainly relies on clinical judgment, imaging manifestations, and some biochemical parameters, but indexes which could be routinely used in clinic are relatively finite [4]. Ideal diagnostic markers should be highly specific and sensitive, rapidly available, inexpensive, and noninvasive [5]. The clinicians have been attempting for years to seek such a biomarker to aid identification for early prevention, intervention, and therapy to prevent adverse cardiovascular and cerebrovascular events. One candidate is red blood cell distribution width (RDW), obtained from a standard complete blood count (CBC). It is a measure of the variability in size of circulating erythrocytes and is indicated as the coefficient of variation of the erythrocyte size [6]. Normally, the size of red blood cells (RBCs) varies from 80 to 100 fL in the blood. Clinical conditions in which RBCs routinely elevated or decreased are usually caused by ineffective RBC production including iron deficiency, vitamin B12 and folate deficiency, increased RBC devastation, and blood transfusion [7]. The alteration of erythropoiesis can result in an extensive RBC size heterogeneity, which suggests that some pathological changes are occurring in organisms. In Table 1, we give a summary of the physiological conditions that lead to alteration of RDW values [8]. RDW is usually calculated by dividing the standard deviation (SD) of the mean corpuscular volume (MCV) by the MCV and multiplying by 100 to yield a percentage value to be on behalf of the RBC size heterogeneity [6]. Since the methods of measuring the RBC size, the instruments, the experimenters, the laboratory standards, and statistical approaches are dissimilar in different laboratories [9], there is no universal reference range till now [10]. The normal reference range of RDW most laboratories used was 11–15% [11]. Figure 1 shows RBC volume normal distribution curve and relative variation in RDW. Figure 2 shows 2 common methods to calculate RDW. Table 1: Physiological conditions that lead to alteration of RDW values. Figure 1: RBCs volume normal distribution curve from an impedance-based hematology analyzer and relative variation in the RBC distribution width (RDW) [40]. Figure 2: (...truncated)


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Ning Li, Heng Zhou, Qizhu Tang. Red Blood Cell Distribution Width: A Novel Predictive Indicator for Cardiovascular and Cerebrovascular Diseases, Disease Markers, 2017, 2017, DOI: 10.1155/2017/7089493