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Red Cell Distribution Width in Critical Patients With COPD

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Red cell distribution width is an important prognostic indicator in critically ill patients with chronic obstructive lung disease. Read below to know more.

Written byDr. Sumedha Kundu Choudhury

Medically reviewed byDr. Kaushal Bhavsar

Published At November 24, 2022
Reviewed AtAugust 14, 2024

Introduction:

Chronic obstructive pulmonary disease (COPD) is ranked as the third most prevalent cause of death all over the world. COPD often coexists with comorbidities such as cardiovascular diseases, anemia, osteoporosis, and skeletal muscle dysfunction. These comorbidities greatly influence the overall morbidity of COPD, leading to increased hospitalization, health care costs, and eventually death.

There is a close association between chronic obstructive pulmonary disease and the red cell distribution width. Red cell width is a measure of variation in the size and volume of the circulating erythrocytes. An increase in the red cell width reflects underlying chronic inflammation, which could further increase the risk of cardiovascular diseases and morbidity due to chronic obstructive pulmonary disease.

What Is COPD?

It is a chronic inflammatory lung disease that results in irreversible airflow obstruction from the lungs. The leading cause of COPD is prolonged cigarette smoking. Other factors that play a significant role in the development of COPD are genetic disorders such as alpha antitrypsin deficiency and occupational hazards due to long-term exposure to obnoxious chemical fumes, vapors, and dust particles, which can inflame the lung parenchyma.

The liver produces alpha one antitrypsin enzyme, which is then secreted into the bloodstream. It helps inhibit the elastase enzyme, which breaks down all the elastin and thus protects the lungs. COPD mainly consists of two disorders: chronic bronchitis and emphysema. These two conditions can co-occur and vary in severity. Chronic bronchitis is inflammation of the bronchial lining. Emphysema is a condition in which the alveolar sac is destroyed due to exposure to irritating toxic gasses and cigarette smoking.

What Is Chronic Bronchitis?

Chronic bronchitis is a condition in which there is sputum production for more than three months per year for more than two consecutive years due to hyperplasia of the mucous gland located in the submucosal layer of the bronchial tubules.

What Is Emphysema?

It is a condition in which there is the absolute destruction of the alveolar sac and simultaneous enlargement of the lung parenchyma that is situated distal to the terminal bronchiole. Cigarette smoking is an important risk factor for emphysema. Smoking stimulates inflammatory cells, like macrophages and polymorphonuclear cells, which secrete elastase and result in elastolysis and emphysema. An important feature of emphysema is the barrel chest, which has a rounded and enlarged chest appearance because of hyperinflation. The anteroposterior to transverse ratio is 5:7 or 1:2, but in the case of emphysema, it becomes 1:1 because of hyperinflation.

What Is the Pathophysiology of COPD?

Increased inflammation of the lining epithelium of the bronchial tubules causes the release of increased inflammatory mediators such as interleukin (IL6), (IL8), tumor necrosis factor(TNF) -alpha, C- reactive protein, and fibrinogen. These inflammatory mediators inhibit erythropoietin-induced erythrocyte maturation, which leads to the release of immature erythrocytes into the circulation and thereby increases the red cell width. The red blood cells are susceptible to oxidative stress, which shortens their life span and increases their width.

What Are the Symptoms of COPD?

The signs and symptoms of COPD include:

  • Shortness of breath.

  • Wheezing.

  • Crepitation.

  • Chest tightness.

  • Persistent cough with sputum.

  • Recurrent infections.

What Is Red Cell Width?

The red cell width measures the amount of red blood cell variation based on volume and size. It is used to measure the hemoglobin and mean corpuscular value. The normal red cell distribution width is 12.2 to 16.1 percent in females and 11.8 to 14.5 percent in males. An increase in the value indicates an underlying disorder, infection, or nutrient deficiency, such as deficiency of iron, folate, or vitamin B12.

What Is Red Cell Width Used for?

Red blood cell width is a part of the complete blood count. A complete blood count provides information on red blood cells, white blood cells, and platelets.

The red cell distribution width test is used to help diagnose:

  • Anemia.

  • Thalassemia.

  • Chronic diseases like Crohn's disease, diabetes, and human immunodeficiency virus (HIV).

  • A diet that is low in iron, folic acid, or vitamin B12.

  • Chronic infection.

  • Excessive blood loss due to an injury.

What Is the Normal Range of the Red Cell Distribution Width (RDW) Test?

The normal range of red blood cell distribution ranges from 12.2 to 16.1 percent in adult females. In adult males, it ranges from 11.8 to 14.5 percent in adult males. If the scores obtained are outside the normal range, it suggests that the person may have a nutrient deficiency, infection, or other disorders.

It was observed that some may have a normal range of RDW but may exhibit medical conditions. In such cases, other blood tests are to be considered to arrive at the diagnosis.

If the RDW is found to be high, it suggests nutrient deficiency, especially iron, folate, or vitamin B12. These results may suggest macrocytic anemia. When the body is unable to produce sufficient amounts of red blood cells, it may produce red blood cells of larger size. The reason is a deficiency of folate or vitamin B12.

In the case of microcytic anemia, red blood cells are less in number and smaller than normal.

These conditions can be diagnosed with CBC (complete blood count). RDW and MCV are compared to measure red blood cell volume. In macrocytic anemia, MCV and RDW are found to be high. In microcytic anemias, MCV is found to be low, and RDW will be high.

Normal RDW with low MCV may result in anemia, which is caused by chronic conditions like chronic kidney disease. When RDW is normal, and MCV is high, it is suggestive of aplastic anemia.

When RDW is found to be low, it is suggested that there is no hematologic disorder.

How Are Anemia and COPD Related?

Anemia is a well-known comorbidity of COPD. The hemoglobin levels with dyspnea, along with several inflammatory mediators in COPD. Anemia with COPD is directly related to adverse clinical outcomes, including death. Anemia has been an independent predictor of recurrent hospitalization and survival in COPD patients with chronic respiratory failure. The low levels of hemoglobin may affect the gaseous exchange and cardiorespiratory interactions. The effect is more prominent in severe COPD patients with acute respiratory failure, in which the demand for oxygen supply increases due to increased respiratory workload.

What Are the Factors Causing an Increase in Red Cell Width?

Factors causing an increase in red cell width are:

  • Inflammation.

  • Ineffective erythropoiesis.

  • Nutritional deficiencies.

  • Bone marrow dysfunction.

How Is Red Cell Distribution Width an Important Marker in Association With COPD?

Red cell distribution width is a useful marker to estimate the outcomes of COPD:

  • It predicts the severity of the disease.

  • It is an independent predictor of mortality.

  • Readmission rate.

  • Pulmonary hypertension.

  • Right heart failure.

What Is the Treatment for COPD?

COPD is a chronic progressive disease, and there is no cure for it. Only symptomatic relief can be provided.

Bronchodilators: Drugs that relax the tubules' muscles and dilate the airways, such as short and long-acting beta-agonists and anticholinergics.

Corticosteroids: Drugs that help to reduce the inflammation of the airways.

Combined inhalers: Bronchodilators and corticosteroids combined as one inhaler.

Antibiotics: Drugs to fight against bacterial infection.

The flu or pneumonia vaccine reduces the chances of developing a respiratory illness.

Mucolytics: Helps in lysis or breaking down the secretions such as Guaiphenesin.

Pulmonary rehabilitation includes exercise, disease management, and proper counseling to stay healthy and active.

Conclusion

An increase in red cell distribution width is useful as a prognostic indicator. It can help physicians to identify patients who are at high risk of poor outcomes. Patients with increased red cell distribution width should be monitored more carefully and closely to improve their prognosis. It can also help in reducing the cost associated with repeated hospitalization.

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Frequently Asked Questions

In individuals with stable chronic obstructive pulmonary disorders, elevated red blood cell distribution width (RDW) values were linked to death (COPD). Limited information on RDW levels in acute exacerbations of COPD (AECOPD) is available. Elevated RDW is observed in several disorders, including congestive heart failure (CHF), COPD, pulmonary hypertension, cerebral disease, and other conditions.

A common laboratory metric that shows the size diversity of circulating erythrocytes is the red cell distribution width (RDW). The differential diagnosis of microcytic anemia is the primary application for which the RDW is employed. It has been described as a predictive tool in conditions including pulmonary arterial hypertension, congestive heart failure, and coronary heart disease. Increased RDW levels in COPD patients may indicate hypoxemia, underlying inflammation, and oxidative stress. To assess the severity of COPD, a cheap and straightforward laboratory measure like RDW might be used as a biomarker.

Red blood cell size or volume change is measured by a red cell distribution width metric or RDW. Red blood cells with a high RDW (above 14.5%) have a wide range in size. RDW ranges from 11.6 to 14.6% normally. However, Intermountain Medical Center Heart Institute researchers discovered that individuals with RDW levels over or equivalent to 12.9% had a higher risk for depression. A high RDW may indicate anemia or disease connected to it. Comparing the findings of an RDW (variation in red blood cell size) with those of an MCV (average red blood cell size) to evaluate the condition of the red blood cells.

A tool used in the differential diagnosis of anemia is the red blood cell distribution width (RDW), which measures the size heterogeneity of erythrocytes. High levels are linked to higher mortality and heightened cardiovascular biomarkers. Red blood cells with a high RDW (above 14.5%) have a wide range in size. RDWs typically range from 11.6 to 14.6%.

A red cell distribution width (RDW) test quantifies the variations in the red blood cells' volume and size (erythrocytes). Every cell in the body receives oxygen from the lungs through red blood cells. The body's cells require oxygen for growth, cell division, and overall health. The red blood cells are typically all around the same size. A high RDW indicates that the smallest and biggest red blood cells are significantly different in size. This can indicate a health issue.

Red blood cells have relatively small size variation when the RDW is low (below 10.2%). Macrocytic anemia is one cause of a low RDW level. In the blood condition known as macrocytic anemia, not enough red blood cells are generated, but those that do are big. Microcytic anemia is another reason for a low RDW level.

Red cell distribution width should fall between 12.2 and 16.1 percent in adult females and 11.8 to 14.5 percent in adult males. If the score falls outside this range, one may have a nutritional shortage, infection, or illness. However, one might still suffer from a medical problem, even with normal RDW levels.


The red blood cells are typically all around the same size. A high RDW indicates that the smallest and biggest erythrocyte cells are extremely distinct in size. This can indicate a health issue.

High RDW has been linked independently to a higher risk of acute pulmonary embolism-related early death, according to a study that was just published. Even though RDW was within the typical reference range, it was found in our study to be linked to an elevated risk of venous thrombosis. RDW was investigated as a function of deaths from all causes, including coronary vascular disease (CVD), cancer, and other causes. Results The probability of mortality was significantly enhanced by higher RDW levels.

A higher-than-normal mean platelet volume (MPV) results in thrombocytopenia, and a lack of platelets, depending on the platelet count and the findings of other blood tests. Blood malignancies known as myeloproliferative disorders occur when the bone marrow produces excessive platelets or other blood cells. Megaloblastic anemia, iron deficiency anemia, etc., frequently have elevated RDW. In regular blood, mean platelet volume (MPV) is a popular indication of platelet activity.

Interestingly, the concentration of red blood cells rises in healthy individuals exposed to low oxygen levels. Red cell percentage (i.e., anemia) frequently decreases rather than increases in those with chronic diseases like COPD. The hepcidin-ferroportin axis and cytokine-mediated development of erythropoietin resistance are likely involved in the etiology of anemia in COPD.

When red blood cells' percentage of blood occupied declines, anemia results, red blood cells typically make up 40–45% of blood in a normal adult. They claim that anemia is rather frequent in those with chronic lung conditions like COPD, particularly when there is persistent hypoxemia (low oxygen levels in the blood). Anemia has recently been identified as a common comorbidity in COPD patients. Anemia can be seen in 7.5% to 33% of people with COPD. The most typical kind of anemia connected to COPD is likely anemia of chronic disease (ACD). Systemic inflammation brought on by COPD fuels ACD.

Red cell distribution width (RDW) has received a lot of interest as a predictive biomarker for various chronic lung illnesses. Recent research by the study team has shown that elevated RDW is linked to poor clinical outcomes in chronic lung disorders such as idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease. Additionally, diseases that alter the structure of red blood cells owing to the early release of immature cells into the circulation (severe blood loss), aberrant hemoglobins (such as sickle cell anemia), hemolysis, or hemolytic anemias can cause an increase in RDW.

If the RBCs are less or bigger than usual, the results of an RDW blood test may be greater, which is a sign that one may be suffering from an underlying ailment. The movement of oxygen from the lungs to other body regions may be hampered if the RDW number is outside the normal range. A nutritional shortage, such as one in iron, folate, or vitamin B-12, may be indicated by an excessively high RDW. These findings could also point to macrocytic anemia, a condition in which the produces fewer normal red blood cells than usual and larger-than-average red blood cells when it does.

Numerous COPD patients have previously been shown to have low hemoglobin values. However, the precise association between hemoglobin concentrations and mortality is unknown. In patients with COPD and chronic respiratory failure, greater hemoglobin levels were related to a longer life. Anemia is a predictive factor in acute exacerbations. Male and female hemoglobin levels of 15.1 g/dL and below 14.3 g/dL, respectively, were independently related to improved results.

A crucial aspect of the etiology of COPD is secondary systemic inflammation from the airways. Patients with COPD have been shown to have elevated levels of fibrinogen, interleukin-6 and -8, C-reactive protein, and white blood cells (WBC). Patients who are thought to have COPD may exhibit the following test results.


- Arterial Blood Gas (ABG)


- Hematocrit.


- Alpha 1 Antitrypsin Levels.


- Blood Test.


- Pulse Oximetry.


- Sputum Culture.


- Human B-type Natriuretic Peptide.


- Serum Electrolytes.

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Dr. Kaushal Bhavsar from iCliniq
Dr. Kaushal Bhavsar

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