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Red Cell Distribution Width (RDW) 

  • Author: Choladda Vejabhuti Curry, MD; Chief Editor: Eric B Staros, MD  more...
 
Updated: Jan 13, 2015
 

Reference Range

Red cell distribution width (RDW) is a parameter that measures variation in red blood cell size or red blood cell volume. RDW is elevated in accordance with variation in red cell size (anisocytosis), ie, when elevated RDW is reported on complete blood count, marked anisocytosis (increased variation in red cell size) is expected on peripheral blood smear review.

The reference range for RDW is as follows:

  • RDW-SD 39-46 fL[1]
  • RDW-CV 11.6-14.6% in adult[2]

Reference ranges may vary depending on the individual laboratory and patient's age.

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Interpretation

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.[1, 3]

RDW-SD (express in fL) is an actual measurement of the width of the RBC size distribution histogram (see the first image below) and is measured by calculating the width (in fL) at the 20% height level of the RBC size distribution histogram (see the second image below). This parameter is therefore not influenced by the average RBC size (mean corpuscular volume, MCV).

RDW-CV (express in %) is calculated from standard deviation and MCV as follows (see the third image below):

  • RDW-CV (%) = 1 standard deviation of RBC volume/MCV x 100%

Of note, since RDW-CV is mathematically derived from MCV, it is therefore affected by the average RBC size (MCV).

RBC size distribution histogram from a Sysmex SE-2RBC size distribution histogram from a Sysmex SE-2100 analyzer from a subject with an MCV of 81.4 fL, RDW-SD of 38.2 fL, and RDW-CV of 12.8%.
Determination of RDW-SD measurement. In this exampDetermination of RDW-SD measurement. In this example, RDW-SD is 38.2 fL.
Calculation of RDW-CV measurement, which is deriveCalculation of RDW-CV measurement, which is derived from 1SD divided by MCV times 100%. In this example, RDW-CV is 12.8%.

RDW is useful in the following conditions:[4, 5, 1]

  • Elevated RDW helps provide a clue for a diagnosis of early nutritional deficiency such as iron, folate, or vitamin B12 deficency as it becomes elevated earlier than other red blood cell parameters.
  • It aids in distinguishing between uncomplicated iron deficiency anemia (elevated RDW, normal to low MCV) and uncomplicated heterozygous thalassemia (normal RDW, low MCV); however, definitive tests are required.[6, 7]
  • It can also help distinguish between megaloblastic anemia such as folate or vitamin B12 deficiency anemia (elevated RDW) and other causes of macrocytosis (often normal RDW).
  • RDW can be used as a guidance for flagging samples that may need manual peripheral blood smear examination, since elevated RDW may indicate red cell fragmentation, agglutination, or dimorphic red blood cell populations.

RDW along with mean corpuscular volume (MCV) is helpful in narrowing the cause of anemia:[8]

Normal RDW and low MCV is associated with the following conditions:

  • Anemia of chronic disease
  • Heterozygous thalassemia
  • Hemoglobin E trait

Elevated RDW and low MCV is associated with the following conditions:

  • Iron deficiency
  • Sickle cell-β-thalassemia

Normal RDW and high MCV is associated with the following conditions:

  • Aplastic anemia
  • Chronic liver disease[9]
  • Chemotherapy/antivirals/alcohol

Elevated RDW and high MCV is associated with the following conditions:

  • Folate or vitamin B12 deficiency
  • Immune hemolytic anemia
  • Cytoxic chemotherapy
  • Chronic liver disease

Normal RDW and normal MCV is associated with the following conditions:

Elevated RDW and normal MCV is associated with the following conditions:

  • Early iron, vitamin B12, or folate deficiency
  • Dimorphic anemia (for example, iron and folate deficiency)
  • Sickle cell disease
  • Chronic liver disease
  • Myelodysplastic syndrome
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Collection and Panels

Collection and panel details are as follows:

  • Specimen: Whole blood, usually collected by venipuncture
  • Collection: EDTA tube (purple/lavender top) containing EDTA potassium salt additive as an anticoagulant (see image below)
    EDTA tubes, purple top. EDTA tubes, purple top.
  • Panels: Complete blood count (CBC)
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Background

Description

Red cell distribution width (RDW) is a parameter that measures variation in red blood cell size or red blood cell volume. RDW is elevated in accordance with variation in red cell size (anisocytosis), ie, when elevated RDW is reported on complete blood count, marked anisocytosis (increased variation in red cell size) is expected on peripheral blood smear review.

Indications/Applications

Red cell distribution width (RDW) laboratory test is a part of a standard complete blood count (CBC), and it is used along with other RBC indices, especially mean corpuscular volume (MCV) to help determine the causes of anemia.

Considerations

Elevated RDW provides a clue for heterogenous red cell size (anisocytosis) and/or the presence of 2 red cell populations, since other RBC indices (MCV, MCH and MCHC) reflect average values and may not adequately reflect RBC changes where mixed RBC populations are present, such as dimorphic RBC populations in sideroblastic anemia or combined iron deficiency anemia (decreased MCV and MCH) and megaloblastic anemia (increased MCV). Peripheral blood smear review can help confirm the above findings in these circumstances.[5, 8, 10]

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Contributor Information and Disclosures
Author

Choladda Vejabhuti Curry, MD Assistant Professor of Pathology and Immunology, Baylor College of Medicine; Hematopathologist and Cytopathologist, Section of Hematopathology, Texas Children's Hospital

Choladda Vejabhuti Curry, MD is a member of the following medical societies: American Society for Clinical Pathology, American Society of Cytopathology, American Society of Hematology, College of American Pathologists, United States and Canadian Academy of Pathology, Society for Hematopathology, European Association for Haematopathology, International Clinical Cytometry Society

Disclosure: Nothing to disclose.

Chief Editor

Eric B Staros, MD Associate Professor of Pathology, St Louis University School of Medicine; Director of Clinical Laboratories, Director of Cytopathology, Department of Pathology, St Louis University Hospital

Eric B Staros, MD is a member of the following medical societies: American Medical Association, American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology

Disclosure: Nothing to disclose.

Acknowledgements

The author wishes to thank Karen Prince for her assistance in RBC size distribution histogram illustrations.

References
  1. Briggs C, Bain BJ. Basic Haematological Techniques. Bain BJ, Bates I, Laffan M, Lewis SM. Dacie and Lewis Practical Haematology. 11th ed. Philadelphia, PA: Churchill Livingstone/Elsevier; 2012. chap 3.

  2. Vajpayee N, Graham SS, Bem S. Basic Examination of Blood and Bone Marrow. McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd. Elsevier/Saunders: Philadelphia, PA; 2011. 30.

  3. Harmening DM, Black A, Culp NB, et al. Principles of Automated Differential Analysis. Harmening DM. Clinical Hematology and Fundamentals of Hemostasis. 5th ed. Philadelphia, PA: F.A. Davis Company; 2009. chap 32.

  4. Ryan DH. Examination of blood cells. Lichtman MA, Kipps TJ, Seligsohn U, et al, eds. Williams Hematology. 8th ed. New York, NY: The McGraw-Hill Companies, Inc.; 2010. Chapter 2.

  5. Perkins SL. Examination of the Blood and Bone Marrow. Greer JP, Foester J, Rodgers GM, et al, eds. Wintrobe’s Clinical Hematology. 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009. Chapter 1:1-20.

  6. Sultana GS, Haque SA, Sultana T, Ahmed AN. Value of red cell distribution width (RDW) and RBC indices in the detection of iron deficiency anemia. Mymensingh Med J. 2013 Apr. 22(2):370-6. [Medline].

  7. Vaya A, Alis R, Suescun M, Rivera L, Murado J, Romagnoli M, et al. Association of erythrocyte deformability with red blood cell distribution width in metabolic diseases and thalassemia trait. Clin Hemorheol Microcirc. 2014 Jul 25. [Medline].

  8. Marks PW, Glader B. Approach to Anemia in the Adult and Child. Hoffman F, Benz EJ, Shattil SJ, eds. Hematology Basic Principles and Practice. 5th. Philadelphia, PA: Churchill Livingstone/Elsevier; 2009. 34.

  9. Tekce H, Kin Tekce B, Aktas G, Tanrisev M, Sit M. The evaluation of red cell distribution width in chronic hemodialysis patients. Int J Nephrol. 2014. 2014:754370. [Medline]. [Full Text].

  10. Elghetany MT, Banki K. Erythrocytic Disorders. McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by laboratory Methods. 22nd. Elsevier/Saunders: Philadelphia, PA; 2011. 32.

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RBC size distribution histogram from a Sysmex SE-2100 analyzer from a subject with an MCV of 81.4 fL, RDW-SD of 38.2 fL, and RDW-CV of 12.8%.
Determination of RDW-SD measurement. In this example, RDW-SD is 38.2 fL.
Calculation of RDW-CV measurement, which is derived from 1SD divided by MCV times 100%. In this example, RDW-CV is 12.8%.
EDTA tubes, purple top.
 
 
 
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