Role of RDW in mathematical formulas aiding the differential diagnosis of microcytic anemia

Abstract

Many mathematical formulas containing simple red blood cell parameters have been proposed for differentiating between iron deficiency and thalassemia in patients with microcytic anemia. Approximately half of these formulas do include red cell distribution width (RDW), along with other red cell parameters. In the present study we investigated the role of RDW, expressed in relative or in absolute units in relation with the formulas’ discriminant performance. We used a database containing over 2200 subjects with microcytic anemia, for whom a final diagnosis (iron-deficiency anemia, thalassemia, both or other) was available. Performance of the discriminant formulas was assessed by Receiver Operator Curve analysis. Substitution of relative by absolute RDW resulted in statistically significant performance increase (area under the ROC curve) in 16 out of 23 formulas, predominantly due to increased specificity. Relevant performance deterioration was seen in only three formulas that had low initial performance already with the original relative RDW. For optimal differential diagnostic performance, an RDW-based formula for distinguishing thalassemia from iron-deficiency anemia in microcytic anemia should contain ‘absolute’ instead of relative RDW.

Keywords:

• Anemia
• iron-deficiency
• erythrocytes
• erythrocyte indices
• ROC curve
• sensitivity and specificity
• thalassemia

Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes. No ethical approval was needed, in accordance with the ethical and scientific guidelines of the Institutional Review Board at Galdakao-Usansolo Hospital.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author contributions

The contribution of the individual authors was as follows: EU acquired the data, JH designed the study, EU and JH performed data analysis and results interpretation. JH and EU wrote and critically revised the manuscript drafts and approved the final version. Both authors accept full accountability for all aspects of the work.