Red cell distribution width effective for early diagnosis of iron deficiency anemia

DELHI (Reuters Health) – Red cell distribution width, a measure of the variation in size of red blood cells, is more sensitive in detecting early stages of iron deficiency anemia than is conventional peripheral smear examination, Indian researchers report.

"An optimal noninvasive method of diagnosing iron deficiency anemia has eluded practitioners for many years," Dr. D. Viswanath writes in the December issue of Indian Journal of Pediatrics.

Dr. Viswanath and colleagues from M. S. Ramaiah Medical Teaching Hospital in Bangalore evaluated 100 children with microcytic anemia who were between the ages of 6 months and 5 years. Red cell distribution width curve and other hematological parameters were measured using automated cell counters, while peripheral smears were analyzed by pathologists. The specific tests for iron deficiency, serum iron and transferrin saturation, were also carried out in all the patients.

The researchers observed that the severity of anemia was mild in 48% of the children with hemoglobin levels between 10 g/dL and 11 g/dL, moderate in 42% with hemoglobin between 7 g/dL and 9.9 g/dL, and severe in 10% with hemoglobin levels below 7 g/dL.

Eighty-nine of the 100 children with anemia were confirmed as having iron deficiency, with a transferrin saturation of less than 16%. The red cell distribution width was high in 82 children with iron deficiency anemia, the researchers report.

Compared with the normal values of between 11.5 and 14.5, the mean red cell distribution width was 17.28 in children with mild iron deficiency, 17.57 in moderate and 21.10 in those with severe iron deficiency anemia. Although the characteristic microcytic hypochromic red blood cells were seen in peripheral smears of all children with severe iron deficiency, they were noted in only 19% of children with mild anemia, the researchers report.

The overall sensitivity and specificity of red cell distribution width in the diagnosis of iron deficiency anemia was 92.13% and 90.9%, while it was 48.31% and 90.9%, respectively, for peripheral smear examination. The researchers observed that the sensitivity of red cell distribution width in the diagnosis of mild and moderate iron deficiency was significantly greater, while both methods were equally accurate in detecting severe anemia.

"The high incidence of iron deficiency anemia in children emphasizes the need for early detection and prompt treatment," the researchers write.

In contrast with manual peripheral smear examination, automated red cell distribution width analysis can facilitate rapid and early diagnosis of iron deficiency anemia, Dr. Viswanath's group concludes

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