If the width of the distribution of erythrocytes is increased. What does an elevated RDW in a blood test mean?

In the process of research, various components of the blood are determined, or rather, their number.

Erythrocytes are blood cells whose task is to:

• maintaining an acid-base balance;
• withdrawal from plasma of various amino acids;
• isotonic support;
• oxygen saturation;
• removal of carbon dioxide from the cells and tissues of the body.

It is quite clear that, of various etiologies, disturbances in the quantitative content of red blood cells in the blood lead to various diseases of the human body as a whole. The main component of the erythrocyte is hemoglobin.

Blood analysis

When examining blood in the laboratory, regardless of its purpose, first of all, studies of the level of leukocytes are carried out, as well as hemoglobin saturation:

• with an increased content of leukocytes, blockage of small vessels can be observed,
• with an insufficient number of red blood cells, oxygen starvation can occur.

In the analysis, there are such concepts as: the average volume of erythrocytes, the content of hemoglobin in one erythrocyte, the concentration of hemoglobin. Also an important indicator is the width of the distribution of erythrocytes, whether it is increased.

Increased red blood cell distribution width

The width of distribution in a healthy person is a value equal to 11.5 to 14.5 percent. With an increase in this indicator, that is, with an increase in the width of the distribution, erythrocytes differ greatly from each other in size. The increased size of erythrocytes shortens their lifespan, which by itself negatively affects the total number of erythrocytes in the blood.

As you know, with a fairly large destruction of red blood cells, as a result of which a large amount of iron, the yellow pigment of bilirubin, is formed in the blood, which enters the liver for further processing. The liver, under this load, cannot fully cope with the processing of iron, which also adversely affects human health. Also, the width of the distribution of erythrocytes with an increase affects the work of the spleen, leading it to increase in size, due to the fact that the spleen removes “non-working” erythrocytes from the body and releases new ones into the blood.

Such increased functionality of the spleen can affect nearby organs. Due to a significant increase, the latter can crush the stomach and intestines. With pressure on the lung, the development of various kinds of diseases of the upper respiratory tract is also possible.

With an increased width of the distribution of erythrocytes, one can, first of all, judge a disease called "iron deficiency anemia". This disease is the most common among anemia. At different stages, the indicator of the width of the distribution of erythrocytes is not increased equally. In the initial stages of the disease, the density index may be normal, but the hemoglobin content index may be lowered.

With the development of the disease, the width of the distribution of erythrocytes increases, that is, individual erythrocytes increase in size. The content of hemoglobin in erythrocytes, on the contrary, decreases, sometimes to a critical level. Treatment of this type of anemia primarily consists in normalizing the level of hemoglobin and its characteristics. Treatment is mainly through medication with the use of drugs with a high iron content.

With an increase in the width of the distribution of erythrocytes, the heterogeneity of erythrocytes is often noticed, that is, erythrocytes are observed in the blood that differ greatly in size. Also, the reasons for increasing the width of the distribution of erythrocytes can be various kinds of chronic liver diseases, lack of vitamin B12, various neoplasms, cancers and other conditions.

Symptoms of an increase in the width of the distribution of red blood cells

With the development of an increased width of the distribution of erythrocytes, various manifestations can be observed.

For example, since in this case there is a considerable effect on the liver and spleen, yellowness of the skin and an increase in body temperature may appear. As with any disease, sweating, loss of strength, drowsiness and fatigue are manifested. On the part of the human nervous system, both excitations and, vice versa, more renounced states are possible. In any case, the symptoms cannot be specifically described, as changes in red blood cells affect many organs.

Consequently, a violation of the width of the distribution of erythrocytes can lead to diseases of a different nature and severity of the course, since the human body is a rather complex system, with a number of interconnected organs and systems. The abnormal functioning of one of them can lead to a malfunction of the body as a whole.

The distribution width of erythrocytes (RDW index): what is it, the norm, increased and decreased

To determine different populations of red blood cells, an indicator (erythrocyte index) is used - the width of the distribution of erythrocytes - RDW or the degree of erythrocyte anisocytosis, which is included in the list of all components of the general blood test (CBC), that is, this parameter is usually not assigned on its own and not tested in the laboratory.

So what does such an erythrocyte index as RDW mean, what information does it carry to specialists and why is it used?

Distribution of erythrocytes by volume

If we examine under a microscope the red blood cells present in the blood of a patient suffering from a certain hematological pathology, we can find that the erythrocytes (Er) are not all the same in volume. Among all non-nuclear biconcave forms, there may be cells that differ significantly in size from normal erythrocytes:

• Large cells - macrocytes;
• Just giants - megalocytes;
• Lilliputian cells, which are called microcytes.

And here it is not necessary to be a specialist in this field in order to understand that red blood elements that have changed their volume will not be able to fully perform their physiological functions (transfer of oxygen and nutrients, regulation of water-salt metabolism and acid-base balance, participation in blood coagulation, etc. .), which, of course, will affect the overall health of the body.

Meanwhile, one should not attach too much importance if ugly forms are present in single copies, it is another matter if they claim an equal position with normal erythrocytes. In order to find out how many in the general population of erythrocytes there are bizarre shapes characteristic of a particular type of anemia, and calculate the width of the distribution of erythrocytes (erythrocyte index RDW).

Many laboratory diagnostic physicians and hematologists take RDW as a coefficient of variation, indicating how much the average red blood cell volume (MCV) deviates from the generally accepted norm, and calculate it using the formula:

where SD denotes the standard deviation of the mean volume of red blood cells, and the MCV index corresponds to their mean volume.

Is it always possible to believe the norm?

The range of normal values ​​of the distribution of erythrocytes by volume varies within 11.5 - 14.5% (in children under six months, the norm, in general, differs markedly and ranges from 14% to 18.7%, although from 6 months the values ​​​​of the indicator are already begin to aspire to the norm of adults).

An elevated RDW in a blood test indicates the degree of heterogeneity (heterogeneity) of red blood cell populations or indicates the presence of several blood cell populations in the sample, which occurs, for example, after a recent blood transfusion.

It is hardly possible to use the term “reduced RDW value” when calculating the width of the distribution of erythrocytes, since this option reflects, as it were, the norm, and therefore cannot be taken as a laboratory indicator characterizing some phenomenon unusual for these blood elements. The less unnatural forms (due to an increase or decrease in volume) of erythrocytes in the blood, the more representatives of the population for this trait are within the normal digital values. And yet, if this happens (RDW - lowered), then, most likely, the analyzer made a mistake, and in order to correct this oversight, the patient will have to provide a finger for a puncture again, and the laboratory staff will have to calibrate the device.

In addition, it should be taken into account that RDW, which is within the normal range, is not always proof of complete health, because in some cases, the distribution of red blood cells by volume is not increased, and clinical manifestations and laboratory tests confirm the presence of the disease (anemia).

Increased RDW

An increased index is quite a suitable indicator even for the differential diagnosis of certain types of anemia, it allows you to distinguish between their forms:

1. Megaloblastic and macrocytic, a typical representative is B12 / folic / -deficiency anemia. In the blood test: hyperchromia, the average volume of Er is above 160 fl, the cell diameter is more than 12 μm, RDW is increased (anisocytosis), different forms of erythrocytes (poikilocytosis);
2. Normocytic: aplastic anemia, as well as anemia caused by chronic pathology (tuberculosis, pyelonephritis, collagenoses, liver disease), a malignant process, or caused by dysfunction of the endocrine system;
3. Microcytic (iron deficiency anemia, in the blood test: hypochromia, anisocytosis towards microcytosis).

True, in such cases, in addition to RDW, the diagnosis also relies on another erythrocyte index - MCV, which characterizes a red blood cell as a normocyte (at 80 x / l - 100 x / l or 80 - 100 femtoliters), microcyte (at - below 80 fl), macrocyte (if the average volume is more than 100 fl).

In addition, when testing blood samples in order to calculate the values ​​of erythrocyte indices (including RDW), it is very important to compare the results obtained with the histogram of erythrocytes, which, after completing their work, is usually issued by modern hematological systems with software.

Thus, an increased RDW with values ​​of the mean erythrocyte volume (MCV) above 100 fl may indicate the following pathological conditions:

• IDA (iron deficiency anemia) - the most common anemic condition (IDA accounts for up to 80% in the entire group of diseases of this kind)
• Sideroblastic anemia (a heterogeneous group of hypochromic microcytic anemias);
• Macrocytic and megaloblastic anemia;
• Myelodysplastic syndromes, which are a hematological pathology that combines a group of heterogeneous diseases with characteristic signs of a decrease in the number of individual populations of blood cell elements (cytopenia) and a clonal disorder of hematopoiesis in the bone marrow (dysplasia). Myelodysplastic syndrome is characterized by a high risk of transformation into a malignant process;
• Bone marrow metaplasia;
• Metastases of malignant tumors in the bone marrow.

Obviously, for a certain range of pathological conditions, the calculation of the width of the distribution of erythrocytes has a very important diagnostic value.

Why is RDW a new indicator for patients?

Previously, until automated hematological systems entered the daily life of the laboratory service, the degree of anisocytosis was determined visually, when viewing a smear using optical equipment. And the distribution width of erythrocytes was not called RDW and was not calculated by a device designed for automatic hematological analysis. The calculation was carried out by a different method - using the Price-Jones curve, which, as it turned out later, did not coincide with the erythrocytometric curves performed by the “smart” machine with maximum accuracy, but it took a lot of effort and time for doctors and laboratory assistants to conduct the study. Now, having placed the sample in the "smart" apparatus, no one asks him one question - to work only on a separate test. The analyzer simply calculates everything that is provided for by the program and is embedded in it, so patients began to see new indicators, which were not even mentioned when processing samples manually.

And such studies were previously of interest mainly to hematologists to clarify the nature of anemia, who, if necessary, turned to the laboratory with a note in the direction: to conduct a morphological study of erythrocytes, calculate and present graphically (Price-Jones erythrocytometric curve) the ratio of the number of red cells with different diameters. Of course, not all blood samples were subjected to such testing, but only samples taken from specific patients. Now, in principle, nothing has changed, this indicator is likely to be of interest to a separate circle of specialists. Well, if RDW is present in the blood test, then patients have the right to ask questions.

Currently, an automatic hematology analyzer successfully copes with the calculation of RDW in a blood test, which quietly, quickly and efficiently solves the problem. And makes RDW everyone.

The relative width of the distribution of erythrocytes by volume is increased or decreased

As a result of blood sampling, in order to exclude a particular disease in humans, doctors in the laboratory conduct the necessary studies to identify pathologies in the collected plasma and its constituent cellular elements in the form of erythrocytes, leukocytes and platelets. The described elements for the performance of their normal function are determined by typical sizes, volumes (CV) and shapes. Therefore, any change in these indicators can affect the vital activity and active functioning of cells and, as a result, lead to various changes in homeostasis. Therefore, in order to be able to correctly assess the described cells, an indicator was developed in the form of a certain index indicating the width of the distribution of erythrocytes (rdw).

Using such an erythrocyte index, it is possible to determine in the hematopoietic system the presence of red blood cells of different volumes, their distribution and the scale of differences between the largest and smallest described elements. Often, the so-called blood cells have a homogeneous structure, and a single volume is indicated, but over time or as a result of the emergence of certain pathologies in humans, some discrepancies may be observed between cells.

Moreover, in nature there are such diseases that can be determined at an early stage of their manifestation only thanks to a blood test for the width of the distribution of erythrocytes - RDW CV.

What determines the width of the distribution of erythrocytes

And so the term described is due to a certain index, the use of which makes it possible for physicians to obtain information about the actual distribution of blood cells of various sizes and shapes. That is, when deciphering this index, you can get information about the percentage of erythrocytes in the hematopoietic system - the size and volume of these cells, which can be increased or decreased.

In order to fill the existing blood cells with oxygen, blood particles need to have a secured passage even into the smallest vessels of the human body. That is why, both in physiological terms and in size, the described bodies must fit the so-called openings of the vessels.

If excessively large or very small described elements are formed in the hematopoietic system, this leads to all kinds of changes in the described structural units of the human body. As a result, a person has a need to designate the cellular component of plasma by using an indicator in the form of RDW CV.

How the study is carried out and what is the norm for the width of the distribution of erythrocytes

Blood for the calculated distribution of the described cells is taken for research in view of:

• Planned analysis;
• Necessary diagnostics of certain pathological phenomena;
• Operable intervention in the human body;
• The origin of the diverse etiology of anemia.

Just the same, the last described pathological conditions are a common indicator indicating the need for certain blood tests. Moreover, the most modern methods of blood sampling from a person make it possible to conduct any examination of the hematopoietic system quite quickly and with high quality, giving a correct assessment of the state of the erythrocytes themselves.

The results of the tests performed will be negative if the described indicators are normal, and positive if the RDW level is high. And only with a second examination, the physician will be able to explain to the patient the pattern and reasons for this increase, since it is impossible to establish a reliable diagnosis based on a single blood sampling. So, for example, after any operation, the described index is usually due to an increased level of RDW.

Blood for research can be taken from an adult patient from a vein, and from a child from a finger. When passing the analysis itself, the recommended last meal should be taken 7-8 hours before the study itself.

To determine the norm of the indicator, age, gender and certain physiological processes occurring in the human body are taken into account. For infants aged 0 to one year, an indicator ranging from 11.5 to 18.7% can be considered the defining value of the norm.

After the first year of life, the digital value of the index begins to approach the norm from 11.5 to 14.5%. In the representatives of the weaker sex, the upper indicator can shift and reach a digital value of 15.5%, as a result of hormonal changes in the body:

• During pregnancy;
• During lactation;
• When using contraceptive means;
• In view of the beginning of the menopause.

Important! Blood sampling should be carried out on an empty stomach. Before the study, you can not use any drugs inside.

In the process of in-depth study of the features of the distribution index of the described cells, it is customary to consider the following two values ​​in the form:

• RDW (SD) - an indicator that determines the standard type of deviation from the norm, is determined by femtoliters and indications of the quantitative difference between large and small cells;
• RDW (SV) - indicates the existing differences in the volumetric value of the described elements and the established average indicators. It is revealed by the percentage correlation of cells that have succumbed to deformation to the mass of all erythrocytes.

Reasons for the increase

The described coefficient of blood cells is higher than normal with an increase in the percentage correlation between small and enlarged cells, in relation to the described elements having sufficient volume. Due to the so-called redistribution of iron-containing protein, which is the basis of blood cells, their smallest number begins to be synthesized in the body, which subsequently leads to the manifestation of various anemias, to anisocytosis - when the main part of the cells has characteristic differences from each other.

According to the foregoing, the main feature of such bodies is their sufficient size, as well as the period of life. As a result of their death, a decent amount of bilirubin is released, which has a very bad effect on all organs of the human body.

The coefficient that distributes blood cells by volume can be high, since there are:

• Lack in the body of such components as iron, folic acid, vitamins belonging to group "B". Such a condition may, not without reason, give a chance for the development of such a disease as anisocytosis, in which there is an increase in this index of elements of the hematopoietic system;
• Oncological diseases leading to the formation of red blood cells of various sizes and volumes in the hematopoietic system;
• Intoxication with chemical elements in the form of the heaviest metals (which is, for example, lead).

All of the above signs of illness should be stopped when using professional therapy. Otherwise, they will seriously harm the body and lead a person to death.

Reasons for the decrease in the indicator

With RDW - CV below normal, the existing elements of the hematopoietic system are indicated by the same size without any differences in cell volume. With a reduced volume indicator under consideration, most often physicians diagnose a condition in the form of microcytosis, in which the elements present in the blood, indicated by small sizes, cannot fully saturate the tissues of the human body with oxygen.

Also, with a decrease in the indicator, a disease is often encountered, accompanied by the unity of the main elements of blood of small sizes, along with a reduced rate of RDW in the form of thalassemia. Which refers to diseases of a hereditary nature, and manifests itself as a violation of the processes of synthesis of iron-containing protein chains, with reduced activation in relation to oxygen. In light of this, plasma is no longer able to participate in the process of gas exchange in a normal and adequate way, which ultimately leads to a change in the functioning of existing organs in humans.

This disease is also characterized by ongoing changes in the morphological properties of blood cells, with inhibition of their growth and a decrease in activity. The clinic of this disease is due to the deformation of the human cranium, the growth of organs, such as the liver and spleen, as well as the icteric color of the skin.

Also, with a reduced ratio of similar blood cells, a disease called microspherocytosis, which is a hereditary ailment, can develop. When such a disease appears in the hematopoietic system, there is more than a nominal small size, a certain form of erythrocytes, along with a decrease in the RDW coefficient, due to their insufficient vital activity. As a result, intravascular cell death occurs and so-called hemolysis develops.

In such a state, a person feels weakness, anemia, a manifestation of jaundice, characteristic of this state, along with changes in the activity of all organs of the human body.

If any of the above symptoms occur, you should immediately seek help from doctors and, for your own safety, conduct a complete examination of the entire body. Only in this way can one protect oneself, thereby preventing one or another disease that may already have arisen.

RBC distribution width (RDW) is normal (table). Red blood cell distribution width (RDW) increased or decreased - what does it mean

The distribution width of erythrocytes or RDW, as this indicator is usually indicated in analyzes, allows you to evaluate not only the number of erythrocytes in the blood, but also the range of their distribution, as well as sizes. From the largest to the smallest and how they differ from each other. As a rule, identical blood cells are approximately equal in volume. And red blood cells are no exception. However, some pathologies violate this balance, and a discrepancy may appear between them, sometimes quite significant. With the RBC Distribution Width Index or RDW, some diseases can be detected at a very early stage when there are no other signs.

Erythrocytes are red blood cells that are the basis of blood. They contain hemoglobin, which is an oxygen transporter throughout the body, maintain the acid-base balance of the blood, remove carbon dioxide from cells and perform other important functions. That is why special attention is paid to red blood cells when analyzing blood - they are studied and compared using several different indices. In particular, the distribution width of erythrocytes is measured using a special hematological device that captures the impulses that transmit erythrocytes. The stronger these impulses, the larger the erythrocytes and vice versa. The measurement result is recorded as a percentage or in femtoliters - fl.

RBC distribution width (RDW) is normal. Result interpretation (table)

The erythrocyte distribution width test is a mandatory component of a clinical blood test. This index is necessary in order to correctly interpret the results of the study and be able to diagnose anemia in time, while at the same time differentiating between them. The distribution width of erythrocytes - RDW - is necessarily compared with their average volume - MCV, since it can often be within the established norm, while the erythrocytes themselves turn out to be too large or, conversely, too small, which in itself indicates the presence of a pathology .

Blood is taken from a vein in adults and from a finger in children. In some cases, a hematological smear is used, but such an analysis often produces incorrect results.

Red blood cell distribution width (RDW) - the norm in ordinary people and pregnant women:

If the distribution width of red blood cells (RDW) is increased - what does it mean

If the distribution width of erythrocytes exceeds 14.5%, this indicates that the sizes of red blood cells differ significantly from each other. There may be several options here. First of all, as already mentioned, it is also necessary to estimate the value of the average volume of erythrocytes MCV, that is, the size of the average space occupied by each individual erythrocyte. If this indicator is also overestimated, then this may indicate the following pathologies:

• liver diseases - this organ is responsible for removing harmful toxins from the body, at the same time it synthesizes important chemical compounds and performs various other functions,
• hemolytic anemia - a pathological condition in which red blood cells are destroyed much earlier than their normal lifespan,
• deficiency of vitamin B12 or folic acid.

If the RDW index is increased, and the MCV index is decreased, then the reasons for this phenomenon may be as follows:

• iron deficiency anemia - due to iron deficiency, an insufficient amount of hemoglobin is produced in the body,
• thalassemia is a blood disease in which the synthesis of elements necessary for the production of hemoglobin is disrupted. At the same time, erythrocytes are fragmented (break up into smaller parts), which leads to a decrease in their average size, while the width of the distribution of erythrocytes remains high.

If the RDW index is elevated, and the MCV remains within the normal range, then this may indicate a deficiency of folic acid or vitamin B12. Or - about the initial stage of iron deficiency anemia.

An increased level of the width of the distribution of erythrocytes indicates that the life span of erythrocytes is shortened, they are destroyed, excess bilirubin and iron are released into the blood. This overloads the liver and prevents it from performing its main functions, and also leads to an increase in the spleen, which has to work in emergency mode in order to utilize the remnants of destroyed red blood cells. This often leads to damage to the organs closest to it - the intestines and stomach. Due to problems with the liver and spleen, patients with elevated red cell distribution width often have an unhealthy yellowish skin tone.

If the distribution width of red blood cells (RDW) is reduced - what does it mean

If the distribution width of erythrocytes (RDW) is below 10.2%, this indicates that the red blood cells differ slightly from each other in size. There are two main reasons for this phenomenon:

• macrocytic anemia is a blood disorder in which there is a shortage of red blood cells. They are synthesized, but their sizes are too large,
• microcetic anemia is a blood disorder in which only abnormally small red blood cells are synthesized.

In both cases, red blood cells are almost the same size, which leads to low RDW.

Other reasons why the width of the distribution of red blood cells decreases:

• oncological diseases,
• myelosis or lymphoma
• destruction of red blood cells or their damage and the release of hemoglobin,
• deficiency of certain vitamins in the body,
• iron deficiency,
• massive blood loss.

However, it must be said that such a situation is quite rare and, as a rule, is the result of a laboratory error.

The distribution index of erythrocytes is lowered: what does it mean and what to do? Decrease in RDW: pathology and norm

The Red Blood Cell Distribution Index (RDW) is a very important factor during a complete blood count. This indicator shows the size and shape of red blood cells.

Red blood cells realize the function of transportation, thereby assisting in the penetration of oxygen into all tissues and organs, while taking away toxins and carbon dioxide accumulated in cells. In the normal state, red blood cells are approximately the same size, which allows them to quickly stick together, forming blood clots.

The indicator of red blood cells in the blood can reflect the presence of pathological processes in the body, especially if the sizes of these cells vary significantly. Next, we will talk about the situations in which the red blood cell distribution index decreases, how it manifests itself and what it indicates.

Reduced RDW: norm and pathology

A person in good health has red blood cells of the same shape, density and color. In the event of a deviation, especially in the presence of autoimmune diseases or oncology, a failure occurs at the level of microcells, when young cells do not receive a certain number of components, which, in fact, slows down their performance. Thus, anemia occurs - a pathology during which the body does not receive the right amount of oxygen, in other words, the metabolic function in red blood cells is impaired.

What does RDW mean in a blood test?

During a general blood test, the distribution index of erythrocytes is determined. If a specific disease is suspected, a blood test is prescribed to determine only this indicator.

Most often, the width of the distribution of erythrocytes by volume is determined in conjunction with the MCV index. This is the average volume of erythrocytes. This happens because these indexes (by number and volume) are closely related and help in determining the type of anemia.

It happens that the distribution index of erythrocytes is lowered. What does it mean? The thing is that for a qualitative judgment about the state of erythrocytes, not only their concentration in the blood is important, but also their shape. An increased distribution of erythrocytes is observed in 1 of the cases, but if the RDW index is lowered, which is much less common, we are talking about the presence of serious problems in the human body.

A blood test to determine the distribution index of erythrocytes can be carried out both during medical examinations (scheduled) and as prescribed, if there are suspicions of any deviations in the hematopoietic function. The analysis is carried out necessarily before surgery, during pregnancy and in childhood.

Why is it necessary to do an analysis on RDW?

It has already been said above that the distribution index of erythrocytes in the blood makes it possible to conduct a qualitative assessment of the composition of red blood cells, given their size.

But why is this necessary? The thing is that these cells are very similar to each other, which gives them the opportunity to replace each other or form blastulae. An increase in cell size entails an increased need for nutrition and, in addition, this means that their lifespan is reduced. All this directly affects the overall rate of red blood cells in the blood and the human condition.

When a large number of red blood cells die, iron is released and there is more bilirubin, which puts an increased burden on the liver, and as a result, it cannot process these substances.

The RDW index is directly related to the pathological process during which the dimensions of red blood cells change (anisocytosis). This condition is a complex chemical process that causes all blood cells to suffer.

How is it calculated?

The RDW indicator is calculated as a percentage, the norm of which is the limit from 11.5 to 14.8. The distribution index of erythrocytes is determined using a mathematical equation, which is the ratio of modified red blood cells and their total mass.

At present, laboratories use computer technology that allows you to calculate the percentage of deviation from the established norm. The results of the calculation are presented in the form of a histogram depicting a curve that indicates the likely changes in the size of red blood cells.

Normal performance

The norms of the erythrocyte distribution index depend on gender, age and the presence of certain conditions that occur in the human body. For children under one year old, the normal rate is 11.5-18.7%. At the age of one and older, the values ​​tend to the generally accepted norm, which is 11.5-14.5%.

For the female half of humanity, the upper limit shifts to 15.5%, because their hormonal levels change too often: during pregnancy, lactation, oral contraceptives, menopause.

For analysis, blood is taken on an empty stomach in the morning (until 9 am). It is very important that before this procedure a person does not take any medications, and also stays in a balanced internal state.

Raise RDW

The level of RDW in some situations is elevated. The most common cause of this pathology is iron deficiency anemia. The indicator can change at different stages of the development of pathology, which clearly reflects the histogram of erythrocytes:

• The initial stage of the development of anemia is characterized by normal indices, but hemoglobin will be greatly reduced. This is the result of healthy functioning of the spinal cord.
• The next stage of development in the histogram will show an increase in RDW. When there are problems with hemoglobin, indicators such as the average concentration and content of hemoglobin in the blood cell, the average volume of red cells decrease.

In the treatment of IDA, it is necessary to normalize the level of iron-containing protein concentration and its characteristics in human blood.

What do low scores mean?

Patients often ask what it means: "erythrocyte distribution index is lowered." Since the erythrocyte distribution index cannot be estimated without a volume indicator, it is necessary to familiarize yourself with all options for underestimated indicators with their relationship:

1. RDW is low, and MCV is below average - indicates the presence of problems with the spleen and liver.
2. RDW is lowered, and MCV is higher than the normal level - indicates the presence of oncological pathologies, mainly the development of bone marrow metastases.

The fact that the distribution index of erythrocytes RDW sd is reduced, from a biological point of view, cannot, in principle, be observed. For this reason, most often the patient is offered to donate blood again, observing the following conditions:

• stop smoking and drinking alcohol within 24 hours before blood sampling;
• before the analysis, do not take any medications;
• refuse to eat smoked and salty foods the day before.

In the case when the distribution index of erythrocytes RDW sd is really lowered, which is necessarily confirmed by deviations from the norm of the MCV indicator, this indicates the occurrence of certain pathologies. These include:

• Hypochromic microcytic anemia - sometimes also called anemia. A condition in which irregularly shaped red blood cells die because they have no biological value in the body.
• Malignant tumors - usually in this case we are talking about mastopathy, bone marrow and lung cancer.
• Hemolysis of red blood cells is the process during which red blood cells die before reaching their target. As a result, active hemoglobin is released.

The reasons

So, the distribution index of erythrocytes is lowered - what does this mean? There are several reasons that can lower the RDW:

• Acute blood loss in trauma and pathological bleeding.
• Frequent operations.
• A metabolic disorder in which the food consumed is not completely digested.
• Hormonal failure, which is most common in women.
• Deficiency in the body of B vitamins and iron.
• Blood diseases characterized by rapid destructive processes.

What measures to take?

What to do when the erythrocyte distribution index is lowered?

A highly qualified doctor at the consultation will most likely ask the patient to take the test again, because the RDW indicator is almost never underestimated. Since this suggests that all cells are ideal in their parameters, and this, in principle, cannot be. If the indicator is confirmed upon re-analysis, then a complete study of the state of the body is carried out, paying special attention to oncological examinations.

Preventive measures

You can prevent a low RDW by following these simple rules:

• The diet should be balanced, which includes a lot of fresh fruits, lean meats and vegetables.
• It is recommended to breathe fresh air as often as possible.
• An active lifestyle will help prevent the RDW index from dropping.
• It is very important not to miss scheduled medical examinations, during which serious deviations from the norm are most often detected that do not have external symptoms.

As a result, we learned that the distribution index of erythrocytes reflects their dimensions relative to each other and makes it possible to learn about their biological value. A decrease in the RDW is very rare, but if the distribution index of erythrocytes is low, this means that various pathologies are possible.

The index is calculated based on the results of a general blood test, but it can only be fully valid in conjunction with the MCV indicator, since they are closely interconnected.

March 6, 2017 | Elena Kolchina | No comments yet

The distribution index of erythrocytes is lowered or increased: what does it mean?

Red blood cell anisocytosis (RDW) is an index of the distribution of red blood cells in terms of size. This parameter evaluates the number of red blood cells of various sizes that deviate from the normal value in a blood test. It is a percentage visualization of erythrocyte heterogeneity.

What indicator is considered normal

In an adult, this indicator is normally in the range of 11.5-14.5%.

Microcytes are erythrocytes less than 6.7 microns. Macrocytes are larger than 8 microns. The study of this indicator is informative in determining the type of anemia. Microcytosis in the analysis indicates the presence of iron deficiency anemia, the development of microspherocytosis, thalassemia, sideroblastic anemia. Macrocytosis is characteristic of deficient anemia (lack of folic acid) and toxic liver damage. A general increase in anisocytosis is observed in macrocytic anemia, iron deficiency anemia, bone marrow lesions, myelodysplastic syndrome, and hemolytic anemia.

In newborns, physiological macrocytosis is observed, passing up to two months of life. In parallel with the anisocytosis index, it is necessary to study the MCV, which takes into account the size of erythrocytes, their average volume, and the content of hemoglobin in them.

General rules for preparing for blood tests

To obtain the most reliable results, the analysis must be carried out on an empty stomach. The interval between blood sampling and the last meal should be at least twelve hours. Water consumption is allowed.

For three days it is recommended to exclude: alcoholic beverages, smoked meats, fried and fatty foods. A few hours before the test, it is not advisable to smoke and exercise. If possible, you should stop taking medications a week before blood sampling (the exception is the control of ongoing therapy). Analyzes are not given after physiotherapeutic procedures, massage, ultrasound diagnostics, rectal examination and radiography.

Increase and decrease in erythrocyte anisocytosis

Iron deficiency anemia is considered the most common cause of changes in the distribution index of erythrocytes.

This is a disease that occurs due to iron deficiency and is accompanied by impaired heme synthesis, leading to anemia of varying severity.

This blood pathology is quite common and accounts for about 80% of all anemias. It most often occurs in women, children and adolescents.

Classification

1. Juvenile - due to a violation of iron metabolism with hormonal imbalance, intensive growth and the formation of the menstrual cycle in girls.
2. The acute posthemorrhagic form is associated with the loss of a large amount of blood in a short time period.
3. Chronic posthemorrhagic iron deficiency anemia occurs with prolonged blood loss (heavy menstruation, hemorrhoids, frequent nosebleeds, untreated stomach ulcers, Crohn's disease, ulcerative colitis, diverticulitis).

According to the severity, mild (Hb in the range of 100-110 g / l), moderate (Hb at least 80 g / l), and severe (Hb below 75 g / l) are distinguished. The risk group for the occurrence of iron deficiency anemia includes: women who have been breastfeeding for more than a year, carrying a fourth or more child, patients with chronic blood loss, donors, vegetarians.

The development of this disease occurs in several stages. Initially, prelatent and latent iron deficiencies are observed, accompanied by its depletion in organs and tissues. Clinical symptoms are manifested at the stage of reducing the iron of heme-containing pigments, which is necessary for the synthesis of hemoglobin.

Clinical picture

The manifestation is a nonspecific anemic syndrome, manifested by pallor of the skin and mucous membranes, drowsiness, weakness, and decreased performance.

Further, dystrophic lesions of the nails join (stratification of their structure, spoon-shaped form, growth retardation). Patients complain of constant dry mouth, difficulty swallowing dry food, the appearance of perverted taste preferences (the desire to eat chalk, raw meat, earth), a change in smell. The most characteristic manifestations are considered: the occurrence of seizures in the corners of the mouth and smoothing of the relief of the tongue (disappearance of papillae).

An objective examination pays attention to the yellowish-gray hue of the face, dryness and flaking of the skin, bluish tint of the sclera.

Diagnostics

The basis for the diagnosis are characteristic complaints and clinical symptoms, hypochromic microcytic anemia in the CBC.

The color index and the level of hemoglobin saturation of erythrocytes are also below normal. In severe anemia, pronounced anisocytosis is characteristic (the distribution index of erythrocytes shifts towards microcytosis) and the development of poikilocytosis. The regenerative parameters of the bone marrow are not disturbed. There is no decrease in the number of reticulocytes.

Indicative are the level of ferritin and the coefficient of saturation with transferrin (lowered).

Evaluation of specific parameters

Iron deficiency anemia is characterized by a decrease in the average diameter and volume of erythrocytes, an increase in the average RDW value.

A distinctive feature is the reduction of iron-containing erythrocytes (siderocytes).

For differential diagnosis with lead intoxication, basophilic puncture of erythrocytes is assessed (in case of poisoning - more rough) and the level of free basophilic protoporphyrin (increased, more than 9.0 μmol / l with lead intoxication).

Treatment of iron deficiency conditions

The first priority is the elimination of background diseases accompanied by chronic blood loss, as well as the normalization of nutrition.

Simultaneously with the drug elimination of iron deficiency, a diet with an increased amount of dietary iron and vitamin C is prescribed, and the use of dairy products is limited.

As drug therapy, bivalent forms (Totem, Vifer, Aktiferrin, Sorbifer) are most effective. The effectiveness of therapy and the increase in hemoglobin values ​​are evaluated every week. In pregnant women, it is advisable to add folic acid to therapy (even with its normal levels in the blood test).

It is important to remember that preventive measures to prevent iron deficiency in children must be started even in the antenatal period. From the second trimester of pregnancy, all women should be given a maintenance dose of iron supplements. In the postnatal period, children receiving artificial feeding and born from multiple pregnancies are given preventive courses.

folate deficiency anemia

Folate deficiency develops in the human body.

The disease often occurs in children, young and middle-aged people, pregnant women. Also, the risk group includes patients with celiac disease, Crohn's disease and ulcerative colitis, bowel cancer.

Clinical picture

Patients complain of weakness, dyspeptic disorders, aversion to food, pain and burning of the tongue, glossitis.

Objectively assessed: pallor of the skin and sclera subikrerichnost, raspberry tongue with a smoothed relief. During auscultation of the heart, arrhythmias, extrasystoles, systolic murmur at the apex are detected.

Diagnostics

In a clinical blood test, anemia, macrocytosis and an increase in the distribution index of erythrocytes. Folic acid levels are below normal with iron and vitamin B12 levels usually normal.

Serum and erythrocyte folate levels are assessed.

Treatment

In the vast majority of patients, the administration of folic acid at a dosage of 1 to 5 mg is sufficient for the treatment of folic acid deficiency anemia. In diseases of the intestine, the dose is increased to 15 mg / day.

The minimum duration of prescribed therapy is one month. Treatment is monitored every two weeks.

Such hemogram indicators are evaluated as:

• the level of erythrocytes and hemoglobin;
• erythrocyte distribution index;
• an increase in the number of reticulocytes.

In the presence of enteropathy, it is necessary to prescribe regular preventive courses with folic acid preparations.

Malignant bowel disease

Accompanied by severe post-hemorrhagic iron deficiency and folic acid deficiency anemia, with a pronounced increase in the distribution index of erythrocytes.

Changes in these indicators, combined with clinical symptoms, make it possible to detect the disease in the early stages and increase the patient's chances of survival and further return to a full life.

Initial manifestations are nonspecific and characteristic of all neoplasms: symptoms of general intoxication (weakness, chills, fever, pain in muscles and joints, refusal to eat), progressive weight loss is observed. Further, dyspeptic disorders (nausea, vomiting), bloating, flatulence, diarrhea join, with damage to the rectum, false urges to defecate appear. Sometimes patients pay attention to the streaks of blood in the stool.

In the process of tumor growth, the general symptomatology changes to a specific one, characteristic of an oncological lesion of the intestine. The amount of blood in the stool increases, complete staining of the feces is possible. This leads to a significant anemia of the patient. There is also a frequent alternation of long-term (up to 10 days) constipation and diarrhea, pain during defecation, a constant feeling of incomplete emptying, and a feeling of a foreign body in the intestine is possible. Characterized by a sharp, fetid odor of feces, a high content of mucus, the appearance of streaks of pus, putrid odor from the mouth. In women, it is possible for the tumor to grow into the vagina, followed by the release of pus, mucus and feces from it.

Diagnostics

Further research includes:

1. Finger examination (informative in case of damage to the rectum).
2. Irrigoscopy (contrast, X-ray examination of the intestine) and colonoscopy (the gold standard of examination for suspected oncological lesions of the intestine, allows you to locate and assess the size of the tumor, perform a targeted biopsy).
3. Fibrocolonoscopy with tumor biopsy.
4. Sigmoidoscopy (the rectum and sigmoid colon are visualized);
5. Computed tomography, radiography, magnetic resonance imaging of organs, ultrasound, ECG, Echo-KG.
6. In women, a vaginal examination is mandatory (possible overhanging of the vaginal vaults, as a result of tumor pressure).
7. Analysis of feces for occult blood.

A complete blood count for bowel cancer reveals anemia, a decrease in the number of platelets, leukocytosis and a sharply increased ESR (erythrocyte sedimentation rate).

In the biochemical analysis, the levels of urea and creatinine will be significantly increased. The rate of haptohemoglobin is sharply increased, the level of total protein, potassium and sodium ions is lowered.

Treatment Predictions

The choice of therapy and its effectiveness are directly dependent on the stage of the disease, the location of the tumor and the presence of metastases. Survival with timely treatment (stage 1) is up to 95%.

Basic Treatments

The use of isolated chemotherapy and radiation treatments for bowel cancer is not effective.

1. At the 1st stage, excision of the tumor is recommended, if necessary, resection of the area of ​​the intestine affected by the tumor. Follow-up with an oncologist.
2. Therapy of the 2nd stage consists in resection, followed by the formation of an anastomosis. Combination of radiation (chemotherapeutic) methods with operational.
3. At the 3rd stage, combined chemo-radiation therapy is necessary.
4. Stage 4 treatment is usually ineffective. Palliative resection of the tumor is used, together with combination therapy.

Prevention of oncological damage to the intestines includes quitting smoking, normalizing nutrition (sufficient consumption of food rich in plant fiber, fresh fruits and vegetables), maintaining a healthy weight, active lifestyle, regular preventive examinations.