The ratio of red blood cell distribution width to serum calcium predicts severity of patients with acute pancreatitis
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Background: COVID-19 is still present in the world, though the extent varies by region and country. According to the World Health Organization, there have been over 617 million confirmed cases of COVID-19 and over 13 million deaths worldwide since the pandemic began on March 10, 2023. Aims and Objectives: This is a study conducted with the aim of providing biomarkers to predict COVID-19 disease progression and mortality based on red cell indices and platelet indices which are commonly measured as part of a complete blood count (CBC). Materials and Methods: A prospective study was conducted during the peak of the second wave of COVID-19 from March 2021 to June 2021. The study included 540 patients who were admitted to the Government General Hospital, Nizamabad, and had tested positive for COVID-19 by RT-PCR. Red Blood Cell (RBC), Hematocrit (HCT), Red cell indices like Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), Red Cell Distribution width (RDW) and Platelet indices like Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT), Platelet–Large Cell Ratio were taken from CBC analyzer Sysmex XN-1000 and analyzed statistically. The patients were then followed up for a period of 14 days to track their outcomes. Results: In the data, majority were male n=334 (62%) and n=280 (38%) were female. 70.37% (n=380) were survivors and 29.63% (n=160) were non-survivors. Red blood cell, red cell indices such as RDW-CV and RDW-SD, and platelet indices such as PCT and PDW were significantly higher in non-survivors compared to survivors with P<0.05. Conclusion: Non-survivors had significantly higher levels of RDW-CV, RDW-SD, PCT, and PDW compared to survivors. These parameters in combination can be useful for predicting COVID-19 mortality at early stage in forthcoming waves.
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Background: Acute pancreatitis is an acute abdominal emergency condition that need immediate hospital stay and intensive care. In 80% of cases it runs a mild course and rest of the patients have severe pancreatitis. It's severity is assessed by using Ranson's scoring system and Modified CT severity index. This study was carried out to evaluate role of Ranson's scoring system and modified CT severity index in assessing severity of acute pancreatitis. Methods: - This is a prospective observational study which is conducted on patients with acute pancreatitis admitted in Department of Surgery, Geetanjali Medical College and Hospital, Udaipur. 30 patients of acute pancreatitis enrolled. Ranson's criteria and modified CT severity index apply to all of them. Results: Out of 30 patients, 20 patients have mild pancreatitis. 4 patients have moderate pancreatitis. 6 patients have severe pancreatitis. Conclusion: We conclude that Ranson's criteria and modified CT severity index have significant role in predicting the severity of acute pancreatitis and the chances of developing complications as regards morbidity and mortality.
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Estimation of the severity state in patient, suffering an acute pancreatitis, while admitting him into a hospital, constitutes a significant part of diagnosis and complex treatment. Application of a highly accurate scales and markers, which are used to prognosticate the disease course severity and to determine the inflammation grade, may influence the results of complex treatment of the patients. In the investigation a high diagnostic accuracy in prognosis of an acute pancreatitis course severity was noted for APACHE II scale (24 hours) and Ranson scale (48 hours). There was established, that determination of a C-reactive protein content has less diagnostic accuracy, but it may be applied as a less complex and more rapid test for prognostication of an acute pancreatitis course severity after admitting the patient to hospital.
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Abstract Background Red Cell Distribution Width (RDW) is a routinely available parameter on automated haematology analysers. This parameter is often used to help in the diagnosis of iron deficiency anaemia. RDW quantitatively measures the degree of anisocytosis of the red blood cells. The more common way of reporting RDW is RDW-CV, which is based on the coefficient of variation of the red blood cell distribution volume and is calculated using mean red cell volume. RDW can also be presented as RDW-SD, which is a direct measurement of the width of the red blood cell distribution curve and is not influenced by mean red cell volume. Conventionally, laboratories report RDW-CV as part of the red blood cell indices in full blood count (FBC) reports. However, it has been proposed that RDW-SD is a better indicator of iron deficiency anaemia compared to RDW-CV. The authors seek to review and assess the clinical utility of both RDW measurements in patients with iron deficiency anaemia in an acute care hospital in Singapore. Methods RDW data of samples from 271 unique individuals from Sysmex XN-9000 (Sysmex, Japan) automated haematology analysers over a period of two months were reviewed. These individuals were selected as they had plasma iron measured in the same blood collection. The individuals were sorted into two groups based on the plasma iron measurement: with iron deficiency (80%) and without iron deficiency (20%). The correlation of RDW-CV and RDW-SD with the plasma iron concentration of the individuals was studied. The RDW-CV reference range used were established for the local population by an in-house reference range validation study while that of the RDW-SD is from a recent Participant Summary Report for a College of American Pathologists (CAP) Hematology Automated Differential survey (FH9-B 2022). The sensitivity, specificity, predictive values, and overall efficiency of RDW-CV and RDW-SD were calculated and compared using the data collected. Results The sensitivity and specificity of RDW-CV in detecting iron deficiency anaemia are 45.2% and 68.5%. The positive and negative predictive values for RDW-CV are 85.2% and 23.7% respectively. The sensitivity and specificity of RDW-SD in detecting iron deficiency are 33.2% and 64.8%. The positive and negative predictive value of RDW-SD are 79.1% and 19.4% respectively. The overall efficiency of RDW-CV is 49.8%, significantly higher than 39.4% of RDW-SD. Conclusion This retrospective study suggested that RDW-CV is still a better blood cell index than RDW-SD in the differential diagnosis of iron deficiency anaemia in a predominantly Asian population. However, the use of RDW-SD reference range that is appropriate for the local population may improve the clinical utility of the RDW-SD.
Anisocytosis
Complete blood count
Hematology
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The Red Cell Distribution width (RDW) which provides a Quantitative measure of heterogeneity of red cells in the peripheral Blood and the mean Corpuscular Volume (MCV) are part of the routine red cell indices reported by automated blood analysis. The study evaluated 250 cases with a wide range of erythrocyte disorders and determined the diagnostic utility of the Red Cell Distribution width (RDW) in relation to the Mean Corpuscular Volume (MCV). Six different groups of erythrocyte disorders by Mean Corpuscular Volume (MCV) and Red Cell Distribution Width (RDW) values are described: Low Mean Corpuscular Volume (MCV)/normal red cell distribution width (RDW), Low Mean Corpuscular Volume (MCV)/High Red Cell distribution width (RDW), normal Mean Corpuscular Volume (MCV)/Normal Red Cell Distribution width (RDW), Normal Mean Corpuscular Volume (MCV)/high Red Cell Distribution width (RDW). High Mean Corpuscular Volume/normal Red Cell Distribution width, High Mean Corpuscular Volume/High Red Cell Distribution width.
Red Cell
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Red cell distribution width (RDW), which is a quantitative method applied for the measurement of anisocytosis, is the most reliable and inexpensive method for differentiation of iron deficiency anemia and thalassemia trait. An increase in its rate reflects a great heterogeneity in the size of red blood cells (RBCs). Recent studies have shown a significant relationship between RDW and the risk of morbidity and mortality in patients with multiple diseases. A strong association is established between changes in RDW and the risk of adverse outcome in patients with heart failure in multiple studies. In this review, we try to focus on the association and correlation between the increase in RDW and different outcomes of common diseases that may be related to RDW and based on the results of various studies, we are trying to introduce RDW as a diagnostic indicator for these diseases.Yousefi B, Sanaie S, Ghamari AA, Soleimanpour H, Karimian A, Mahmoodpoor A. Red Cell Distribution Width as a Novel Prognostic Marker in Multiple Clinical Studies. Indian J Crit Care Med 2020;24(1):49-54.
Anisocytosis
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Acute pancreatitis is a common digestive disease of which the severity may vary from mild, edematous to severe, necrotizing disease. An improved outcome in the severe form of the disease is based on early identification of disease severity and subsequent focused management of these high-risk patients. However, the ability of clinicians to predict, upon presentation, which patient will have mild or severe acute pancreatitis is not accurate. Prospective systems using clinical criteria have been used to determine severity in patients with acute pancreatitis, such as the Ranson's prognostic signs, Glasgow score, and the acute physiology and chronic health evaluation II score (APACHE II). Their application in clinical practise has been limited by the time delay of at least 48 h to judge all parameters in the former two and by being cumbersome and time-consuming in the latter. Contrast-enhanced computed tomography is presently the most accurate non-invasive single method to evaluate the severity of acute pancreatitis. It cannot, however, be performed to all patients with acute pancreatitis. Therefore, considerable interest has grown in the development of reliable biochemical markers that reflect the severity of acute pancreatitis. In this article we critically appraise current and new severity markers of acute pancreatitis in their ability to distinguish between mild and severe disease and their clinical utility.
Pancreatic Disease
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