Red cell distribution width (RDW) is a red blood cell parameter that measures variability of red cell volume/size (anisocytosis). Depending on the types of hematology analyzer instruments, RDW can be reported statistically as coefficient of variation (CV) and/or standard deviation (SD), RDW-CV and/or RDW-SD, respectively.
RDW-SD takes measurements in "fL" and basically measures the width of red cells size distribution histogram – it calculates the width at the 20% height level of the histogram. The average RBC size therefore has no effect on this parameter and you get MCV or mean corpuscular volume.
RDW-CV is expressed in percentage and is calculated from MCV and standard deviation.
The reference range for RDW is as follows:
RDW-SD 39-46 fL
RDW-CV 11.6-14.6% in adult
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A high RDW means that the red blood cells vary a lot in size. There are many possible reasons why the RDW level can be too high. To determine what the possible cause of a high RDW level is, a comparison is made to the mean corpuscular volume (abbreviated MCV).
The MCV is the average amount of space occupied by each red blood cell.
If both the RDW and MCV levels are increased, there are several possible causes:
1. One possible cause is liver disease:
The liver is the largest organ in the body and is responsible for filtering (→ removing) harmful chemical substances, producing important chemicals for the body, and other important functions. Liver disease can increase RDW-SD due to several interconnected factors related to the liver's role in blood health and maintenance:
→ Hemoglobin Synthesis:
The liver plays a critical role in the synthesis of hemoglobin. Liver disease can impair this function, leading to imbalances in hemoglobin production and, consequently, red blood cell production.
→ Iron Metabolism:
The liver is central to iron metabolism, storing excess iron and releasing it as needed. Liver dysfunction can disrupt this balance, resulting in either iron deficiency or overload, which can both cause variations in red blood cell size and lead to a higher RDW-SD.
→ Erythropoietin Production:
While most erythropoietin (a hormone that regulates red blood cell production) is made in the kidneys, liver disease can indirectly affect its levels, impacting red blood cell maturation and leading to a greater variation in their sizes.
→ Dyserythropoiesis:
Liver diseases, particularly those causing cirrhosis (a condition in which your liver is scarred and permanently damaged), can lead to ineffective erythropoiesis, which is the production of red blood cells that are often of abnormal size or shape.
→ Nutrient Processing:
The liver processes many nutrients critical for red blood cell development, including vitamins B12, folate, and iron. Liver disease can lead to deficiencies in these nutrients, which are necessary for the proper production of red blood cells, thus resulting in a higher RDW-SD.
→ Inflammation:
Chronic liver disease is often associated with systemic inflammation, which can negatively affect red blood cell life span and production.
2. Another cause of high RDW & MCV levels is hemolytic anemia:
Hemolytic anemia can increase RDW-SD due to the premature destruction of red blood cells (RBCs) and the body's response to that destruction. Here's how it affects RDW-SD:
→ Premature RBC Destruction: Hemolytic anemia is characterized by the rapid destruction of red blood cells, which can occur in the bloodstream or in the spleen. This destruction shortens the lifespan of RBCs and leads to a decrease in their number.
→ Increased Reticulocyte Count: In response to anemia, the bone marrow increases production of new red blood cells, called reticulocytes, which are usually larger and less dense than mature red blood cells. This release of immature RBCs into the bloodstream increases the variability in cell size, thereby raising the RDW-SD.
→ RBC Size Variation: The presence of both smaller, potentially damaged red blood cells and larger, immature reticulocytes in circulation causes a wide variation in cell size, which is reflected by an increased RDW-SD value.
→ Response to Treatment: If the cause of hemolytic anemia is treated, such as stopping a medication that is causing the hemolysis (destruction of red blood cells) or treating an underlying infection, there may be a transient increase in RDW-SD as the bone marrow produces new RBCs to replace the ones that were destroyed.
→ Coexisting Deficiencies: Hemolytic anemia can be associated with nutrient deficiencies due to increased turnover of red blood cells. These deficiencies, particularly of vitamin B12, folate, or iron, can contribute further to the heterogeneity in red blood cell size.
→ Oxidative Stress: Conditions causing hemolytic anemia can also lead to oxidative stress, which can damage the red blood cell membrane and cause variation in red blood cell shapes and sizes.
Another scenario is that the RDW level can be high, but the MCV level can be low:
1. This can happen because of iron deficiency anemia.
Iron deficiency anemia is a decrease in hemoglobin in the blood that is caused by an inadequate supply of iron. Hemoglobin is a substance present in red blood cells that help carry oxygen to cells in the body. Iron is needed to make hemoglobin, which is why a decreased amount of iron leads to a decreased amount of hemoglobin.
2. Another cause of a high RDW level and a low MCV level is thalessemia intermedia.
Thalessemia intermedia is another type of blood disorder in which there is impaired production of one or more of the elements that make up hemoglobin. If the red blood cells are fragmented (broken) into smaller parts, this can cause the RDW to be high and the MCV to be low. In this situation, the red blood cells vary in size when they are broke up (which is why the RDW level is high) but the cells do not take up much space (which is why the MCV level is low).
A final possibility is that the RDW level is increased and the MCV level is normal.
This can be caused by the beginning stages of a decrease in vitamin B12 or folic acid in the body. It can also be caused by the beginning stages of iron deficiency anemia (see above).
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A low RDW (below 10.2%) means that the red blood cells vary very little in size. One reason for a low RDW level is macrocytic anemia. Macrocytic anemia is a blood disorder in which not enough red blood cells are produced, but the ones that are present are large. Another cause of a low RDW level is microcytic anemia. Microcytic anemia is a condition in which abnormally small red blood cells are present. In these two disorders the red blood cells do not vary much in size because they are either all small or all large. This is what causes the RDW level to be low.
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Haemoglobin (g/L), Hematocrit (Female range), Hematocrit (HCT) / Packed Cell Volume (PCV), Hemoglobin, Hemoglobin (Female range), Mean Cell Volume, Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC), Mean Corpuscular Volume (MCV), Mean Platelet Volume (MPV), Platelet count / Platelets, Platelet Distribution Width (PDW), Platelet-large cell ratio (P-LCR), RBC (Female range), RDW-CV (Red Cell Distribution Width) in %, RDW-SD (Red Cell Distribution Width) in fL, Red Blood Cells (Erythrocytes / RBC), White blood cells (Leukocytes / WBC)
