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The Patient with Anemia and Iron Deficiency
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Haye H. van der Wal, Peter van der Meer
In routine clinical practice, anemia is diagnosed using hemoglobin or hematocrit levels as surrogate markers for a reduced red cell mass, which is the strict definition of anemia. The most commonly used definition for anemia is a hemoglobin concentration <12 g/dL (7.5 mmol/L) for women and <13 g/dL (8.1 mmol/L) for men.29 A distinction should be made between “true” anemia (i.e., reduced hemoglobin and erythrocyte count) and pseudo-anemia caused by fluid overload, leading to hemodilution (i.e., reduced hemoglobin with normal erythrocyte count).10,30,31 Therefore, hemoglobin levels should ideally be measured when the patient is in a euvolemic state. In patients with acute decompensated HF, the absolute change in hemoglobin during intravenous diuretic therapy—indicating hemoconcentration—is an independent predictor of mortality.1 Other hematological parameters, such as mean corpuscular volume (MCV), red cell distribution width, and reticulocyte count may be normal in anemic patients. In a large, observational cohort of chronic HF patients, MCV was often within the normal range and not significantly associated with either vitamin B12 or folate levels. Therefore, MCV should be used cautiously in the differential diagnosis of anemia in chronic HF patients.6
Peripheral Blood and Bone Marrow
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Fermina Maria Mazzella, Gerardo Perrotta
The qualitative assessment must correlate with quantitative factors [red blood cell (RBC) count, hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (MCV), red cell distribution width (RDW)] and must explain flags generated by the automated cell-counting instruments.
The Role of the Clinical Laboratory in Nutritional Assessment
Published in Aruna Bakhru, Nutrition and Integrative Medicine, 2018
The CBC is useful in iron deficiency because hemoglobin and the hematocrit are low. The mean corpuscular volume (MCV) is low in pure iron deficiency but may be in range in combined deficiencies with vitamin B12 or folate deficiencies. The red cell distribution width (RDW) often is increased with anemia, reflecting increased variability in the size of the red blood cells. An elevated RDW may be among the first signs of iron deficiency. The platelet count may be slightly elevated due to cross-reactivity of erythropoietin or in response to anemia, with thrombopoietin that stimulates platelet production. On the peripheral blood smear, the erythrocytes are microcytic and hypochromatic. In contrast to thalassemias, target cells are not observed in iron deficiency.
Pathological mechanisms of abnormal iron metabolism and mitochondrial dysfunction in systemic lupus erythematosus
Published in Expert Review of Clinical Immunology, 2021
Chris Wincup, Natalie Sawford, Anisur Rahman
Red cell distribution width [RDW], a measure of variability in erythrocyte size and volume, has been suggested as a useful surrogate marker of functional iron deficiency. Interestingly, previous studies have demonstrated that patients with SLE have an elevated RDW when compared with healthy controls irrespective of anemia status [70]. In addition, Hu et al reported in 2013 that RDW shows correlation with erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and SLE Disease Activity Index 2000 [SLEDAI-2 K] scores in a retrospective study of 131 patients with SLE [71]. Furthermore, Zou et al noted that an elevated RDW at diagnosis correlates with disease activity and also predicts worse therapeutic outcomes in SLE [72]. We have also observed that RDW correlates with fatigue scores in three diverse groups of patients with the disease [73]. In comparison, there was no correlation between fatigue scores and the commonly used serological markers of disease or disease activity scores, thus suggesting that abnormal iron metabolism rather than disease activity per se may play a role in the pathogenesis of this symptom.
Update on diagnosis and treatment of immune thrombocytopenia
Published in Expert Review of Clinical Pharmacology, 2021
Rajeev Sandal, Kundan Mishra, Aditya Jandial, Kamal Kant Sahu, Ahmad Daniyal Siddiqui
Isolated thrombocytopenia is the most common finding on routine hemogram in ITP patients. In addition, anemia may be present which is usually proportional to the magnitude of bleeding. If anemia is out of proportion to bleeding severity, other causes like nutritional deficiency should be ruled out. RBC indices [mean corpuscular volume (MCV) and red cell distribution width (RDW)] may provide clues regarding anemia arising from nutritional deficiency (vitamin B12, folic acid and/or iron deficiency). Megaloblastic anemia can also present with thrombocytopenia. Peripheral blood smear should be checked by an expert pathologist [15,16]. Apart from isolated thrombocytopenia, it generally shows no abnormality except large or giant platelets which may sometimes be found. Abnormalities on peripheral blood smear examination may help to diagnose other conditions inconsistent with ITP; like schistocytes in microangiopathic hemolytic anemia (MAHA), leukocyte inclusion bodies in myosin heavy chain 9–related disease (MYH-9), and blasts in acute leukemias [17–19].
Red cell distribution width/albumin ratio is associated with 60-day mortality in patients with acute respiratory distress syndrome
Published in Infectious Diseases, 2020
Jung-Wan Yoo, Sunmi Ju, Seung Jun Lee, Yu Ji Cho, Jong Deog Lee, Ho Cheol Kim
Acute respiratory distress syndrome (ARDS) is a non-cardiogenic pulmonary oedema induced by lung injury caused by inflammation, which results in fatal respiratory failure [1,2]. It is a severe condition which affects critically ill patients with a high rate of mortality [3]. Systemic or pulmonary inflammation contributes to the development and progression of ARDS [4–6]. It is important to identify inflammatory markers or combined indices that can predict clinical outcomes of ARDS [7]. Red cell distribution width (RDW) is a measurement of the variability of the size of red blood cells and increases in systemic inflammation [8]. RDW has been linked to clinical outcomes in various clinical settings [9–11] and some studies have reported that RDW is associated with outcome in critically ill patients, including those with septic shock and ARDS [12,13]. Albumin is an important protein responsible for the oncotic pressure in the human body [14] and is associated with pulmonary vascular permeability in critically ill patients [15]. It may be a biomarker that can predict and monitor the severity of ARDS [16]. RDW and albumin are routinely measured in clinical practice. The clinical utility of the RDW/albumin ratio as a combined index has not yet been evaluated in patients with ARDS.