Assessment of the Severity of CAD Regarding Number of Vessels Involved

Background: Coronary artery disease (CAD) is characterized by atherosclerotic plaque accumulation in the epicardial arteries. The dynamic nature of the CAD process results in various clinical presentations. Red blood cell distribution width (RDW) is a practical, widely available marker for assessing the severity of coronary artery disease and helps in the risk stratification of patients with CAD. This study aimed to analyze the severity of CAD regarding the number of vessels involved. Material & Methods: This descriptive cross-sectional study included 124 purposively selected patients who underwent elective CAG in the Department of Cardiology, Chittagong Medical College Hospital, Chattogram, from January 2020 to June 2021. SPSS 23.0 software was used for processing and analysis at the end of the data collection period. Results: The age of the patients ranged from 32-75 years with a mean (±SD) age of 53.4 (±9.9) years. The majority of the patients (83.1%) were male with a male-to-female ratio of 4.9:1. On coronary angiography, the majority of the patients (51/124, 41.1%) had triple vessel disease, followed by double vessel disease in 23 (28.5%) patients, single-vessel disease in 31 (25.0%). In 19 (15.4%) patients no significant lesion was observed in any of the vessels. Gensini score ranged between 1 and 176 in the study with a median score of 56.77. The majority of the patients (69.4%) in the present study had a Gensini score ?30 indicating severe stenosis. A positive correlation between RDW and coronary artery disease severity in terms of Gensini score (r=0.393). With the increase of RDW, the Gensini score increases. It was found statistically significant (p=<0.001) by Pearson’s correlation test. There was a positive correlation between RDW and CAD severity regarding the number of vessels involved (rho =0.5). With the increase of RDW, the number of involved vessels increases. It was found statistically significant (p=<0.001) by Spearman’s correlation test. The Median (IQR) value of RDW was 13.5 (13.0-14.0) in patients with mild stenosis compared to 14.5 (13.9-15.0) in patients with severe stenosis. This difference was statistically significant (p<0.001). The median (IQR) value of RDW was the lowest in patients without any significant stenosis in any of the coronary arteries [13.1% (12.7%-13.5%)] and was the highest in patients with triple vessel diseases [14.5% (14.1%-15.0%)]. Conclusion: This study demonstrated that RDW level was an independent predictor for CAD and the severity of coronary stenosis. So, it can be concluded that RDW is an inexpensive routine laboratory test that might help identify high-risk patients before planning for a more invasive treatment strategy.

Effect of Prenatal Dietary Pattern on Maternal Anemia and Low Birth Weight in Rural Areas of Kanpur

Background: In India, the dietary pattern of women from low socioeconomic status are almost same during pre-pregnant, pregnant and lactating periods. Additional foods are required to improve weight gain in pregnancy and birth weight of infants. Aim & Objective: To identify the impact of prenatal dietary pattern on maternal anemia and low birth weight in rural areas of Kanpur Nagar. Methods: This study was a cross sectional study conducted amongst mothers who recently delivered (RDW) in rural blocks of District Kanpur Nagar. Data was collected by interviewing study subjects using a semi-structured interview schedule after applying multistage random sampling technique. Results: Out of 102 women studied, 39.2% women had consumed >90 IFA tablets, 49.1% of mothers had practiced MMF and 47.1% of women practiced MDD during their prenatal period and 40.1% babies of current pregnancy were born as LBW. IFA consumption during pregnancy was significantly associated with maternal anemia. MMF during pregnancy was significantly associated with LBW. Conclusions: In our study it was found that IFA consumption, MMF and MDD during antenatal is a key preventive measure to reduce anemia status in pregnant females and birth weight of baby during prenatal period.

The relationship between red cell distribution width and prognostic scores in myelodysplastic syndrome

ABSTRACT Introduction: The myelodysplastic syndrome (MDS) represents a group of hematopoietic neoplasms that is characterized by clonal hematopoiesis, cytopenia and abnormal cellular maturation. Red cell distribution width (RDW) refers to the variation degree of erythrocyte size and it is a reflection of anisocytosis. Higher values have been linked to adverse outcomes, such as increased mortality, vascular events, kidney and liver disease and demonstrated to harbor poor prognosis in solid and hematological malignancies. The RDW value can be used as a contributing parameter for MDS diagnosis, as well as its prognosis. In this study, we essentially aimed to demonstrate the correlation between the RDW and MDS prognostic indexes. Materials and methods: Ninety-four MDS patients at the Aydın Adnan Menderes University Hematology Division were included in the study. The correlations between the RDW and laboratory values (either lactate dehydrogenase, albumin, globulin or ferritin) and the RDW prognostic scoring indexes (IPSS, WPSS, IPSS-R and LR-PSS) were investigated. The PASW for Windows, version 21.0 (SPSS Inc., Chicago, IL, USA), was used for statistical assessment. A p-value below 0.05 was the cut-off for the statistical significance. Results: The mean age of all the patients was 73 ±10 years. Patients were observed for 41.88 ± 25 months. The mean RDW value for all cases was 15.5 ± 2.39. We found a statistically significant difference of survival between RDW values below and above 15.5% (p = 0.016). A significant difference was also observed according to the prognostic scoring indexes (see below). Conclusion: An increase in RDW is probably related to dysplasia in the MDS and this constitutes a possible explanation for the poor outcome. Prognostic indexes might incorporate the RDW as a parameter in the future.

CRP COMPARISON WITH RDW AS A PROGNOSTIC MARKER FOR OUTCOME OF OP POISONING

Background: Organophosphate (OP) compounds are frequently used as pesticides in countries. This ease of availability of the OP compounds has resulted in a gradual increase in unintentional and 1 suicidal poisoning, mainly in developing countries . Elevated RDW is associated with systemic in?ammation and oxidative stress More severe poisoning means more production of free radicals and more oxidative stress. In AOPP, toxins may cause 2,5 lesions in tissues and organs in the body, leading to increased plasma CRP levels . Aim: 1-To measure CRP, serum acetylcholinesterase, red cell distribution width, in acute organophosphorus poisoning.2- To analyze the correlation between these biochemical parameters and serum acetylcholinesterase levels. 3-To analyze the validity of these biochemical parameters in prediction of severity and prognosis in op poisoning. Hospital based Methods: prospective study was conducted from OP compound consumption patients attending casualty and admitted patients in S. Nijalingappa Medical College Hospital and Research center, BAGALKOT. Patients less than 18 years, Co-ingestion of organophosphorus with other agents, Pre hospital cardiac arrest, Prior history of Iron de?ciency anemia, Vitamin B12 de?ciency and folate de?ciency anemia, Recent hemorrhage, Chronic liver disease, Prior chemotherapy, Patient on oral contraceptive pills, Patient on estrogen therapy is excluded. Results: a total of 60 patients who diagnosed with history of poisoning were involved in the study among them 29 (48.3%) were male and 31 (51.7%) were female. 75% of study population has attempted suicide by taking the poisoning and 10% of study population had accidental consumption of poisoning, and 5% of study population had occupational exposure. There is negative correlation between the cholinesterase, RDW and CRP as cholinesterase in Conclusion: creases RDW and CRP decreases and severity of poisoning decreases and as cholinesterase decreases RDW and CRP increases and severity of op poisoning increases and morbidity and mortality increases.

Correlation Of Serum Albumin And Red Cell Distribution Width (RDW) With Deep Vein Thrombosis And Pulmonary Embolism A Retrospective Study

Background:Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a severe and potentially lethal disease, with serious short and long?term complications and a potentially fatal outcome. Objective:To determine the correlation of Serum Albumin and Red cell Distribution Width( RDW),with deep vein thrombosis and pulmonary embolism.Materials & Methods: A retrospective study was carried out from the archive of patients with an event of VTE admitted in theGeneral Medicine ward, Jhalawar Medical College, Jhalawar, Rajasthan. Patients’ demographics, presenting symptoms, laboratory tests particularly RDW and Serum Albumin, medications, interventions, and outcomes were collected.Result:A total of 131 cases wereevaluated. Majority of the patients (48.8%) were in age group 45-64 years. The mean duration of hospitalization stay of venous thromboembolism (VTE) patients was 6.6 ± 1.4 days. Mean RDW (%) of the total study participants was 15.3 ± 1.4. Mean serum albumin of the total study participants was 3.3 ± 0.8.Conclusion:Majority of the patients were found with higher RDW and Low Serum Albumin.

Significance of Mentzer Index and Erythrocyte Indices to Evaluate Erythrocyte Morphology and Spectrum of Anemia in Adult Population in a Tertiary Care Hospital in Rural Haryana

Anemia, reduced red cell mass below normal range, results in reduction of oxygen carrying capacity of bloodthat results in tissue hypoxia. MCV, MCH, MCH and RDW represent a sensitive indicator to study erythrocytemorphology. Mentzer Index recommended MI<13 to be suggestive of â-TT and MI>13 for Iron deficiencyanemia. 100 cases were analyzed prospectively over a span of 1 year at MMIMSR, Mullana. The studyrevealed 34% of patients to be in age group of 21-30 years with (59%) female predominance out of whichmajority of cases were of moderate anemia (73%). Erythrocyte indices revealed pattern with majority ofsamples having MCV, MCH and MCHC to be in normal range while RDW showed increased values. Mentzerindex came out to be >14 in 96% of samples. To conclude evaluation of erythrocyte indices and Mentzerindex aids in quatitative assessment of anemia and also to distinguish between iron deficiency anemia andthalassemia trait.

Red cell distribution width as mortality prognostic factor in patients 65 and older with hip fracture / Amplitud de distribución eritrocitaria - RDW como factor pronóstico en pacientes mayores de 65 años operados de fractura de cadera

ABSTRACT Objective: To determine the prognostic value of RDW in patients with hip fracture and its association with selected variables such as unfavorable functional grade, postoperative complications, comorbidities, previous fracture, age and sex. Method: A clinical trial with both retrospective and prospective components study was carried out among 99 patients hospitalized at the Hospital Central de la Fuerza Aérea del Perú [Central Hospital of the Peruvian Air Force], from January 2014 to July 2015, with a follow-up at 6 months for the evaluation of mortality and degree of dependence. RDW and association with related variables were investigated. Results: High RDW values (Q4 RDW> 14.1) were strongly associated with increased mortality (OR = 5.41 CI: 2.35-12.46 p = 0.000) and with an increased patient dependence grade (OR = 1.607 CI : 1.074-2.44 p = 0.040)., with respect to the other quartiles. A positive trend was observed with the highest RDW values and the antecedent of previous fracture showed a significant association with mortality at 6 months. Conclusion: RDW is a simple, easy and widely available parameter in the total red blood cell count. Our study shows that both the RDW and the antecedent of previous fracture are associated with an increased risk of mortality at 6 months after discharge, in addition RDW is associated with an increase in patient dependence after hip fracture.

RESUMEN Objetivo: Determinar el valor pronóstico de RDW en pacientes con fractura de cadera y su asociación con variables seleccionadas como grado funcional desfavorable, complicaciones postoperatorias, comorbilidades, fractura previa, edad y sexo. Método: Se realizó un ensayo clínico con un estudio de componentes prospectivo y retrospectivo realizado entre 99 pacientes hospitalizados en el Hospital Central de la Fuerza Aérea del Peru con un seguimiento a los 6 meses para la evaluación de la mortalidad y el grado de dependencia. RDW y asociación con variables relacionadas fueron investigados. Resultados: Los valores altos de RDW (Q4 RDW> 14.1) se asociaron fuertemente con una mayor mortalidad (OR = 5.41 IC: 2.35-12.46 p = 0.000) y con un mayor grado de dependencia del paciente (OR = 1.607 CI: 1.074-2.44 p = 0.040), con respecto a los otros cuartiles. Una tendencia positiva se observó con los valores más altos de RDW y el antecedente de fractura previa mostró Una asociación significativa con la mortalidad a los 6 meses. Conclusión: RDW es un parámetro simple, fácil y ampliamente disponible en el total de sangre roja recuento de células. Nuestro estudio muestra que tanto el RDW como el antecedente de fractura previa son asociado con un mayor riesgo de mortalidad a los 6 meses después del alta, además de RDW se asocia con un aumento en la dependencia del paciente después de una fractura de cadera.

Comparison of the efficacy of iron amino acid chelate and ferrous sulfate in the treatment of iron deficiency anemia among pregnant women seen at the out-patient department of a tertiary medical center on 2016-2017 / Philippine Journal of Obstetrics and Gynecology

Background@#Anemia is a major global problem that affects women and prevalent during pregnancy. Effective management is needed to prevent adverse maternal and pregnancy outcomes. Ferrous iron salts are the preparation of choice and recommended for both prevention and treatment of iron deficiency anemia (IDA). However, most commonly available iron supplement are poorly absorbed, with gastrointestinal disturbances as side effect.@*Objective@#To compare the efficacy of iron amino acid chelate and ferrous sulfate in the treatment of IDA among pregnant women seen at the out-patient department of a tertiary medical center.@*Methodology@#This study is a single blind randomized clinical trial which included women 18 to 40 years old, with singleton pregnancies diagnosed with IDA without any co-existing fetal and maternal complications seen at the OutPatient Department. Forty eight eligible participants were randomized, with 24 women allocated on each treatment arm who took their assigned treatment twice a day for 90 days. Hemoglobin, hematocrit, MCHC, MCV, RDW & serum ferritin levels were taken at baseline and monitored on days 30, 60 and 90 from initiation of treatment. Mean blood parameters between two treatment arms were compared on days 30, 60 and 90 post-treatment as well as the mean difference of blood parameters on days post-treatment from the baseline using T-test. Chi-square was used to compare adverse effects between two treatment arms.@*Results@#No statistically significant differences in the mean blood parameters on days 30 and 60 of treatment between Iron amino acid chelate and Ferrous sulfate. It was only on day 90 from initiation of treatment when there were a significantly higher hematocrit and MCHC and lower RDW in Iron amino acid chelate compared to Ferrous sulfate group. All of the CBC parameters on days 30, 60, and 90 post-treatment when compared to baseline level were significantly increased for both treatment arms. However, day 90 level of serum ferritin in the Iron amino acid chelate group significantly increased unlike those in ferrous sulfate group.@*Conclusion@#Iron amino acid chelate is comparable to Ferrous sulfate in the treatment of IDA among pregnant women. Iron amino acid chelate was found to be superior to Ferrous sulfate in achieving optimum treatment response even at a lower dose with lesser adverse effects. Hence, better oral iron treatment tolerability, thereby, compliance to long-term therapy can be expected resulting to successful treatment outcome.

Comparação entre os valores da amplitude de distribuição de diâmetro dos eritrócitos e do volume corpuscular médio com a citometria de eritrócitos em cães com leishmaniose / Comparison of amplitude values of the diameter distribution of erythrocyte volume and mean corpuscular cytometry with erythrocytes in dogs with leishmaniasis

A leishmaniose é uma zoonose de caráter endêmico que acomete diferentes espécies animal, dentre elas os cães. Como auxílio no diagnóstico e prognóstico do paciente é rotineiramente solicitado o hemograma, que é caracterizado por uma anemia do tipo normocítica e normocrômica. Os valores de volume corpuscular médio (VCM) e concentração de hemoglobina corpuscular médio (CHCM) são os padrões utilizados para a classificação da anemia, no entanto, nos últimos anos começou-se a utilizar a amplitude de distribuição de diâmetro dos eritrócitos (RDW) para diferenciar as anemias em regenerativas e arregenerativas. Este trabalho tem como objetivo comparar os valores de RDW e do VCM com a citometria eritrocitária em cães com leishmaniose. Foram colhidos sangue de 19 cães de diferentes raças e idades. As amostras sanguíneas foram processadas em equipamento automático para obtenção dos valores de VCM e RDW e posteriormente confeccionados esfregaços sanguíneos para contagem e medição de cem células eritrocitárias de cada lâmina. Para avaliar a dispersão entre os valores de hemácias utilizou-se o coeficiente linear de Pearson. Os valores de RDW mostraram-se mais sensíveis a anemia do que o VCM, quando comparados a citometria eritrocitária.(AU)

Leishmaniasis is an endemic zoonosis that affects different animals species, among them the dogs. As an aid in the diagnosis and prognosis of the patient is routinely asked the CBC, which is characterized by anemia normocytic and normochromic type. The mean corpuscular volumes (MCV) and mean corpuscular hemoglobin concentration (MCHC) are the standards used for the classification of anemia, however, in recent years begun to use the amplitude diameter distribution of red blood cells (RDW) to distinguish anemias in regenerative and arregenerativas. This study aims to compare the RDW and MCV values with the erythrocyte cytometry in dogs with leishmaniasis. blood of 19 dogs of different breeds and ages were collected. The blood samples were processed in automatic equipment to obtain the MCV and RDW and later made blood smears for counting and measuring erythrocyte hundred cells from each slide. To evaluate the dispersion between the RBC values used the linear coefficient of Pearson. The RDW were more sensitive to anemia than VCM as compared with erythrocyte cytometry.(AU)

Correlation analysis between red cell volume distribution width and the mortality rate in ARDS patients after renal transplantation / 器官移植

Objective To investigate the correlation between red cell volume distribution width (RDW) and the mortality rate of acute respiratory distress syndrome (ARDS) patients after renal transplantation. Methods Clinical data of 106 ARDS patients undergoing renal transplantation were retrospectively analyzed. According to RDW, all patients were assigned into the normal (≤15.0%, n=68) and increasing RDW groups (>15.0%, n=38). Baseline data and the incidence of adverse events were statistically compared between two groups. Kaplan-Meier survival curve was adopted to compare the 50 d-mortality rate between two groups. Cox's proportional hazards regression model was utilized to identify the risk factors of the mortality of ARDS patients. Results Among 106 patients, the 50 d-mortality rate was calculated as 43.4% (46/106). The sequential organ failure assessment (SOFA) score, serum creatinine, hemoglobin and platelet count significantly differed between two groups (all P<0.05). In the increasing RDW group, the 50 d-mortality rate and the incidence of infectious shock were significantly higher than those in the normal RDW group (both P<0.05). Kaplan-Meier survival curve demonstrated that the 50 d-mortality rate significantly differed between two groups (P<0.01). Cox's proportional hazards regression model univariate analysis revealed that hemoglobin level<100 g/L, serum creatinine>133 μmol/L, platelet count<100×109/L, severe ARDS and RDW>15.0% were the potential risk factors of the 50 d-mortality rate in ARDS patients (all P<0.05). Multivariate analysis demonstrated that severe ARDS [odd ratio (OR)=12.77, 95%confidence interval (CI) 11.63-15.39, P<0.001] and RDW>15.0% (OR=2.01, 95%CI 1.02-3.94, P<0.043) were the independent risk factors of the 50 d-mortality rate in ARDS patients. Conclusions RDW elevation is correlated with the severity of disease and 50 d-mortality rate in ARDS patients following renal transplantation. RDW can serve as a clinical parameter to predict the prognosis of ARDS patients after renal transplantation.

Clinical study of MCV, MCH and RDW in the diagnosis of iron deficiency anemia in children / 中国生化药物杂志

Objective To study the clinical diagnostic value of MCV, MCH and RDW in children with iron deficiency anemia.Methods40 cases of children with iron deficiency anemia in our hospital from May 2014 to May 2016, were selected as iron deficiency anemia group, another 40 healthy children were chosen in our hospital underwent the healthy control group, using imported reagent in 2h in the MCV, MCH and RDW index value is read out, and then the children of the two groups of MCV, MCH and RDW values were statistically analyzed.ResultsThe levels of iron, and zinc in children with iron deficiency anemia were significantly lower than those in healthy control group (P<0.05), but there was no significant difference in copper, calcium and magnesium levels between the two groups;The MCV and MCH values of children with iron deficiency anemia group were significantly lower than those in healthy control group (P<0.05),the RDW value was significantly higher than that in healthy control group (P<0.05).ConclusionMCV, MCH and RDW detection for clinical diagnosis of iron deficiency anemia in children is high, can be an effective basis for clinical prevention and early diagnosis and treatment of iron deficiency anemia in children, it is worthy of clinical application.

Study on Relationship between Red Blood Cell Distribution Width Changes and Prognosis of Acute ;Myocardial Infarction / 实用医学杂志

Objective To explore the value of? red blood cell distribution width (RDW) changes in acute myocardial infarction (AMI) prognosis by analysing relationship between red blood cell distribution width, cardiac troponin I (cTnI) and high-sensitivity C-reactive protein. Methods 140 hospitalized patients with AMI were selected from May 2014 to October 2014 and devided into 2 groups. 70 patients without heart failure were AMI1 group and the other 70 patients with heart failure were AMI2 group. 70 cases of healthy persons were selected as control group. RDW was compared between three groups and the relationship between the level of RDW, cTnI and hs-CRP was analyzed. Evaluating value of RDW in predicting heart failure in AMI patients by using univariate logistic regression analysis and ROC curve analysis. Results In the comparison of AMI1 group, AMI2 group and control group, either of RDW, cTnI and hs-CRP showed a trend of increasing (P < 0.01). In the AMI patients , RDW level and cTnI level were positive correlation , and there was no linear correlation between RDW level and hs-CRP level. RDW≥14.55% was the independent risk factors in predicting heart failure in patients with AMI. Conclusion RDW≥14.55% can be an available independent predictor of the prognosis of AMI.

Elevated RDW level and its meaning in patients with AECOPD / 实用医学杂志

Objective To study the value of RDW in severity evaluation and prognostic assessment of COPD. Methods Retrospective study was carried out on 115 COPD patients and 50 healthy controls. Blood routine, CRP, IL-6 data were collected on admission aiming at analyzing RDW difference in patients and controls, severity, severity grading and evaluation of prognosis. Results The level of CRP, RDW, IL-6 and WBC in patients were higher than that of healthy controls(P < 0.05). Mild and moderate groups have no significant difference from each other in terms of RDW, CRP and IL-6 conparison, but the difference between any other two groups were significant. There were significant positive correlation between RDW and CRP, IL-6, and negative correlations between the post-bronchodilator FEV1% and RDW. The mortality rate for patients with higher RDW level was higher than those with normal RDW. Conclusion Elevated RDW levels on admission are associated with severity of patients with COPD. RDW may be a prognostic marker for COPD.

Utilization of maternal and neonatal care services in rural Lucknow: a community bases cross sectional study.

Introduction: In India, report says that we failed to achieve the Millennium Development Goals. The maternal mortality rate and infant mortality rate in developing regions are approximately 15 times higher than developed countries. Hence safe delivery and essential newborn care, besides neonatal care in domestic setting and timely referral for cases unmanageable are important areas to be addressed. This study was aimed to assess the current pattern of utilization of maternal and neonatal care services in rural areas of Lucknow. Material and Method: This community based cross sectional study was conducted in between August 2014 to July 2015. Study site was rural area of Lucknow. The study unit was a recently delivered woman, defined as a woman who gave live birth in last one year. A multi stage random sampling technique was used. We uses SPSS version 17 for our statistical analysis. Results: We interviewed 368 RDWs and found that 10.6 % of RDWs did not visit even once to health care facility and almost 62% of registered RDWs were registered early. About 70% RDWs completed at least three ANC visits, 67.7% received complete course of tetanus toxoid and 79.1% received at least one hundred of iron and folic acid (IFA) tablets. Approximately 90% deliveries were conducted by qualified physicians in government institution. There was a clear reduction in facilitating services by health care workers before and after delivery. We found that age less than 30 years, higher socioeconomic strata, educational level higher than matriculation of RDWs were likely to complete their ANC cares and these associations were statistically significant. Conclusion: We are still far away from health for all. To achieve SDG, a multi prong approach is need of hour.

Non-invasive fibrosis indexes in assessment of esophageal varices in patients with hepatitis B virus-related cirrhosis / 中华传染病杂志

Objective To investigate the predictive value of red cell volume distribution width RDW),RDW to platelet ratio (RPR),aspartate aminotransferase (AST) to platelet ratio index APRI),fibrosis index based on the 4 factor (FIB-4) and aspartate-alanine aminotransferase ratio (AAR) in assessing esophageal varices (EV) in patients with hepatitis B virus (HBV)-related cirrhosis.Methods Between December 2013 and July 2015,a total of 190 patients with HBV-related cirrhosis and no previous history of endoscopic therapy for EV hospitalized at the Department of Hepatology,Tianjin Third Central Hospital were enrolled.Upper gastrointestinal endoscopy were conducted in all patients to diagnose EV.According to the morphology and degree of EV as well as bleeding risk,patients were categorized into mild,moderate and severe stages.RDW,platelet counts,alanine aminotransferase,aspartate aminotransferase were tested,and RPR,APRI,FIB-4,AAR were calculated.Spearman correlation was used to evaluate the association between EV and these indexes.Receive operating characteristic (ROC) curves were generated and the areas under the curves (AUC) were calculated to assess the performance of these indexes in predicting esophageal varices bleeding (EVB).Results RDW ([16.78±2.27]％),RPR (0.41±0.18),FIB4 (8.99±5.91),APRI (2.09[1.35,2.90]) in patients with EVB were all significantly higher than those ([14.37±1.86]％,t=-7.449;0.19±0.09 [t=-8.132];5.72±3.92 [t=-3.658];1.29 [0.70,2.39;z=-2.996]) without EVB (all P＜0.05).However,AAR had no statistical significance between two groups (t =1.216,P=0.226).Both of EV and EVB had positive correlation with RDW,RPR,FIB-4 and APRI (all P＜0.05) and no correlation withAAR(P＞0.05).RDW (F=9.604),RPR (F=47.530),FIB-4 (F=18.071) and APRI (H=12.320) showed statistically significant differences among patients with different stages of EV (all P＜0.05),whereas AAR showed no difference (F=1.177,P=0.320).The AUC of RPR (0.896) for EVB was highest,followed by RDW (0.824,P＜0.05).AUC of FIB-4 and APRI was 0.690 and 0.642,respectively,with no statistical difference (P＞0.05).The optimal cut-off levels of RDW,RPR,FIB-4 and APRI were 14.450 (sensitivity:88.24％,specificity:64.03％),0.209 (sensitivity:96.10％,specificity:69.10％),6.912 (sensitivity:66.67％,specificity:73.38％) and 1.338 (sensitivity:76.47％,specificity:51.08％),respectively.Conclusions RPR and RDW are closely correlated with EV in HBV-related cirrhotic patients,which are of clinical importance in predicting EVB.Both of them can be used as clinical screening methods and RPR may be superior to RDW.Although FIB-4 and APRI are correlated with EV,their predictive value of EBV are low.

Evaluation of RDW-CV, RDW-SD, and MATH-1SD for the detection of erythrocyte anisocytosis observed by optical microscopy / Avaliação de RDW-CV, RDW-SD e MATH-1SD na detecção da anisocitose dos eritrócitos visualizados na microscopia óptica

INTRODUCTION AND OBJECTIVE: To evaluate the performance of red cell distribution width reported statistically as coefficient of variation (RDW-CV), standard deviation (RDW-SD), and mathematical deduction of 1 standard deviation (SD) around mean corpuscular volume (MATH-1SD) in identifying anisocytosis in automated blood counts when compared with the manual quantification of erythrocyte anisocytosis in peripheral blood smears. MATERIAL AND METHODS: 806 routine samples obtained from the hematology laboratory of Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) were analyzed. Performance evaluations were carried out by dividing samples into microcytic, normocytic and macrocytic mean corpuscular volume (MCV). For each MCV range, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and efficiency were calculated. In addition, the Youden index (Y) was obtained and a comparative analysis with receiver operating characteristic (ROC) curves was done to evaluate the performance of RDW-SD, RDW-CV, and MATH-1SD on different MCV ranges. RESULTS AND DISCUSSION: RDW-CV had the best sensitivity (86.8%) and efficiency (86.8%) in detecting anisocytosis in microcytic MCV ranges. RDW-SD and MATH-1SD were more sensitive and efficient in normocytic (82.9% and 83.3%; 92.1% and 92.3%, respectively) and macrocytic (90.2% and 90.2%; 95.1% and 95.1%, respectively) MCV ranges. A ROC curve analysis indicated that RDW-CV was more efficient in detecting anisocytosis in microcytic MCV ranges (p < 0.05 vs. RDW-SD and MATH-1SD). In normocytic and macrocytic MCV ranges, RDW-SD and MATH-1SD showed similar efficiency in detecting anisocytosis (p < 0.05 vs. RDW-CV). CONCLUSION: RDW-SD, RDW-CV, and MATH-1SD deliver different performances in detecting blood smear anisocytosis according to MCV values. They are parameters that complement each other and should be used together to identify erythrocyte size heterogeneity.

INTRODUÇÃO E OBJETIVO: Avaliar o desempenho do red cell distribution width expresso em coeficiente de variação (RDW-CV) e desvio padrão (RDW-SD) e da dedução matemática de 1 desvio padrão (DP) ao redor do volume corpuscular médio (MATH-1SD) ao identificar anisocitose nos hemogramas automatizados, quando comparados com o método manual de quantificação da anisocitose eritrocitária em lâmina. MATERIAL E MÉTODOS: Foram analisadas 806 amostras obtidas da rotina laboratorial da Seção de Hematologia do Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR). As avaliações de desempenho foram realizadas dividindo-se as amostras em volume corpuscular médio (VCM) microcítico, VCM normocítico e VCM macrocítico. Para cada faixa de VCM, sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e eficiência foram determinados. Além disso, o índice de Youden foi calculado e uma análise comparativa de curvas de características de operação do receptor (curvas ROC [receiver operating characteristic]) foi realizada para verificar o desempenho de RDW-CV, RDW-SD e MATH-1SD em diferentes faixas de VCM. RESULTADOS E DISCUSSÃO: O RDW-CV obteve a melhor sensibilidade (86,8%) e eficiência (86,8%) ao detectar anisocitose em faixas de VCM microcítico. O RDW-SD e o MATH 1SD foram mais sensíveis e eficientes em VCM normocítico (82,9% e 83,3%; 92,1% e 92,3%, respectivamente) e macrocítico (90,2% e 90,2%; 95,1% e 95,1%, respectivamente). A comparação de curvas ROC demonstrou que o RDW-CV foi mais eficiente ao detectar anisocitose em VCM microcítico (p < 0,05 vs. RDW-SD e MATH-1SD). Em VCM normocítico e macrocítico, o RDW-SD e o MATH-1SD mostraram eficiência semelhante ao detectar anisocitose (p < 0,05 vs. RDW-CV). CONCLUSÃO: RDW-CV, RDW-SD e MATH-1SD possuem desempenhos diferentes ao detectar anisocitose em lâmina conforme a faixa de VCM. São parâmetros que se complementam e que devem ser utilizados em conjunto na identificação de heterogeneidade dos tamanhos eritrocitários.

Study of parents of β-thalassemia major children to determine cutoff values of hematological parameters for diagnosis of β-thalassemia trait and assessment of anemia in them.

Background: Because of the overlapping MCV, MCH and HbA 2 values in BTT and non-BTT subjects our laboratory determined own cutoffs. Aims: To establish cutoff values by investigating the parents of thalassemia major children and to assess the degree of anemia in BTT subjects. Materials and Methods: Study includes 179 parents of thalassemia major children (BTT cases) and 287 non-BTT controls. Samples were analyzed on an electronic hematology analyzer. The samples having MCV ≤ 76 fl and MCH ≤ 27 pg were quantified for HbA 2 by cellulose acetate electrophoresis and grey zone samples were confirmed on HPLC. Statistical Analysis Mean ± SD, sensitivity, specificity, PPV, NPV and accuracy were calculated. The histograms were plotted for MCV, MCH and HbA 2 . Results: Cases having MCV ≤ 76 fl and MCH ≤ 27 pg if considered as suspected cases of BTT then we could have missed five known BTT samples. Sensitivity increased to 100% in all three diagnostic parameters when the cutoff values were raised and specificity for MCV and MCH was decreased. But specificity was 100% with raised cutoff for HbA 2 . Hb and HCT mean values were significantly reduced in BTT cases compared to controls (P < 0.001). In 100% females and 84.9% males having BTT, mild to moderate anemia was observed. Conclusion: In our setup, the cutoff values are MCV (≤78.0 fl), MCH (≤28 pg) and HbA 2 (>3.8%) for BTT diagnosis and there is a mild to moderate anemia in BTT cases.

Dietary carotenoid-rich oil supplementation improves exercise-induced anisocytosis in runners: influences of haptoglobin, MnSOD (Val9Ala), CAT (21A/T) and GPX1 (Pro198Leu) gene polymorphisms in dilutional pseudoanemia ("sports anemia")

Physical training induces beneficial adaptation, whereas exhaustive exercises increase reactive oxygen-species generation, thereby causing oxidative damage in plasma and erythrocytes, fractions susceptible to lipid peroxidation. Pequi (Caryocar brasiliense Camb.) is a Brazilian Cerrado fruit containing a carotenoid-rich oil. The aim was to investigate the effects of pequi-oil on exercise-induced oxidative damage in plasma and erythrocytes, after running in the same environment and undergoing weekly training under the same conditions as to type, intensity and length. Evaluations were accomplished after outdoor running on flat land before and after ingestion of 400 mg pequi-oil capsules for 14 days. Blood samples were taken after running and submitted to TBARS assay and erythrogram analysis. Haptoglobin, MnSOD (Val9Ala), CAT (21A/T) and GPX1 (Pro198Leu) gene polymorphisms were priorly investigated, so as to estimate genetic influence The reduction in erythrocytes, hemoglobin and hematocrit after pequi-oil treatment was notably associated with higher plasma expansion. Except for MCHC (mean corpuscular hemoglobin concentration) and RDW (red cell distribution width), the results were influenced by the polymorphisms studied. The best response to pequi-oil was presented by MnSOD Val/Val, CAT AA or AT genotypes and the GPX1 Pro allele. The significantly lower RDW and higher MHCH values were related to pequi-oil protective effects. Pequi oil, besides possessing other nutritional properties, showed protective blood effects.

Índices eritrocitarios en la esferocitosis hereditaria / Erythrocyte indexes in hereditary spherocytosis

La esferocitosis hereditaria es un grupo heterogéneo de desórdenes caracterizados por la variabilidad en la clínica, en los defectos proteicos del citoesqueleto eritrocitario y en el tipo de herencia. Se estudió la sensibilidad y especificidad de la concentración de hemoglobina corpuscular media (CHCM) y el índice de amplitud de distribución eritrocitaria (ADE) en el screening diagnóstico de la esferocitosis hereditaria. Noventa y cuatro pacientes fueron comparados con niños sanos de igual sexo y edad. Todos los índices se obtuvieron por impedancia eléctrica (autoanalizador hematológico Coulter JT). En los pacientes con esferocitosis hereditaria, la CHCM (35.67±1.33 g/dl) y el ADE (20.60±4.5%), fueron significativamente más elevados que en el grupo control (CHCM 33.48±0.68 g/dl, p 0.000; ADE 13.22±0.9%, p 0.000). Con los valores de corte utilizados en nuestro laboratorio (CHCM ≥ 34.5 g/dl; ADE ≥ 14.5%) ambos índices elevados mostraron una sensibilidad de 81% y una especificidad de 98.9% en el screening de esferocitosis hereditaria. La combinación de ambos índices es un excelente predictor para el diagnóstico de esferocitosis hereditaria.

Hereditary spherocytosis is a group of heterogenous disorders characterized by variability in its clinical manifestations, membrane protein defects and inheritance. We analysed the sensitivity and specificity of mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW) in the diagnostic screening of hereditary spherocytosis. Ninetyfour patients were compared to equal number of healthy, age-matched children. All indexes were derived from measurements obtained by aperture impedance (Coulter Counter Model JT). In patients with hereditary spherocytosis, MCHC (35.67±1.33 g/dl) and RDW (20.60±4.5%) were significantly higher than in normal control subjects (MCHC 33.48±0.68 g/dl, p: 0.000; RDW 13.22±0.9%, p: 0.000). By using a cutoff for the MCHC of 34.5 g/dl and for the RDW of 14.5%, both indexes showed a sensitivity of 81% and a specificity of 98.9%. The combination of the two test is an excellent predictor for the diagnosis of hereditary spherocytosis.

An Analysis of MCV, RDW, HDW and EPO Concentration in Anemia of Acute Infection / 대한소아혈액종양학회지

PURPOSE: The purpose of this study was to assess the usefulness of mean corpuscular volume (MCV), red cell distribution width (RDW) and hemoglobin distribution width (HDW), which can be measured easily with automatic blood cell counter, in differentiating anemia of acute infection from iron deficiency anemia (IDA) in the early phase of infection. We also wanted to determine whether decreased erythropoietin (EPO) production contribute to the pathogenesis of anemia of acute infection. METHODS: 39 anemic children who were admitted to Kangbuk Samsung Hospital due to acute infectious disease between June 1997 and September 1998 were studied. We measured serum ferritin level by radioimmunoassay and divided the patients into two groups according to the serum ferritin level. The children with serum ferritin level above 30 ng/mL were included in anemia of infection group, and the children with serum ferritin level under 10 ng/mL were included in IDA group. Anemic children whose ferritin level were between 10 ng/mL and 30 ng/mL were excluded. We measured MCV, RDW and HDW by automatic blood cell counter and compared them between two groups. We also measured EPO concentration in anemia of acute infection group and compared with that of the control group. RESULTS: 1) Most common acute infectious disease accompanied by anemia of acute infection were acute gastroenteritis, acute pharyngitis, and pneumonia. 2) Complete blood count (CBC) revealed normocytic normochromia in anemia of acute infection and microcytic hypochromia in IDA. MCV of IDA group was significantly lower than that of anemia of acute infection group (65.2+/-8.7 fL vs 82.4+/-5.5 fL, P<0.005). RDW in IDA group was significantly higher than that of anemia of acute infection group (17.1+/-2.5% vs 15.0+/-1.0%, P<0.005). HDW in IDA group was significantly higher than that of anemia of acute infection group (3.2+/-0.5 g/dL vs 2.4+/-0.2 g/dL, P<0.005). 3) The mean EPO concentration in anemia of acute infection group was significantly higher than that of control group (27.1+/-14.5 mU/mL vs 18.4+/-8.7 mU/mL, P<0.05). CONCLUSION: 1) We concluded that MCV, RDW and HDW are effective parameters to differentiate anemia of acute infection from IDA. 2) Decreased EPO production may have less significant role in the pathogenesis of anemia of acute infection compared to anemia of chronic disease. 3) Our results suggested that other factors such as accelerated erythrocyte destruction or hypoferremia may contribute to the development of anemia of acute infection. Further studies will be required to identify the pathophysiology of anemia of acute infection.