Key Highlights: 

• Red cell distribution width (RDW) measures variation in red blood cell size and volume. 
• High RDW may indicate nutrient deficiencies, anaemia, or other underlying conditions. 
• RDW test is often part of a complete blood count (CBC) aiding the diagnosis of different types of  anaemia. 
• Besides anaemia, elevated RDW values correlate with cardiovascular health, inflammatory conditions, cancer, and mortality. 
• Identifying and addressing the cause of high RDW may help improve patient outcomes; regular monitoring of RDW levels is also important. 

Introduction 

When your healthcare provider orders a blood test, you may come across the term “red cell distribution width” (RDW). This parameter measures the variation in the size and volume of your red blood cells. Maintaining uniform red blood cell sizes helps transport oxygen efficiently throughout the body. High RDW values indicate abnormalities in your red blood cells, which can be due to nutrient deficiencies, anaemia, or other underlying conditions. In this article, we will delve into the importance of RDW in blood tests, how it’s used to interpret laboratory results, and its clinical significance in diagnosing various diseases. 

Red Cell Distribution Width (RDW) Test 

Purpose of the RDW test 

Here are the reasons why an RDW test is done.  

• It helps figure out various types of  anaemia. 
• It aids in finding anaemia causes. 
• It offers data about general red blood cell health. 
• This test is also used along with others for a full health check-up. 
   

Preparing for the RDW test 

You don’t need any special preparation for this test. If other tests are planned too, there might be a request to fast. If there’s any need for preparation, your healthcare provider will guide you. 

How is the RDW test performed? 

The RDW test is a basic blood draw. The test needs about 5 minutes for sample collection. After that, the sample heads to the laboratory for testing. Blood is taken from an arm vein with a tiny needle. Once your blood fills in the tube, the needle is taken out, pressure gets applied, and a small band is placed. If you notice excessive bleeding after the draw, inform your doctor at once. 

Interpreting RDW Results 

1. Normal RDW range 

Adult females should have RDW between 12.2% to 16.1%, and in adult males, it must range from 11.8% to 14.5%. If your levels don’t match this range, you need extra tests to find the cause. 

2. High RDW results 

High RDW shows a big change in the size and shape of red blood cells. The causes and importance of high RDW are described below. 

• Causes of high RDW 

• Shortage in nutrients (iron, folate, or vitamin B-12) 
• Anaemia (of various forms) 
• Autoimmune problems 
• Liver or kidney disease 
• Heart problems 
   

• Clinical significance of high RDW 

High RDW can assist doctors in finding and differentiating anaemia types and other health issues. More blood tests, such as mean corpuscular volume (MCV), grant key data for correct diagnosis and advice on management. 

3. Low RDW results 

Low RDW levels show same-sized and shaped red blood cells. No blood disorders have been linked with low RDW results. 

• Factors affecting RDW values 

There are certain factors that may cause RDW to fluctuate, making it tricky to interpret. Blood infusions can momentarily change blood makeup, leading to changes in RDW. Further, blood thinners and MCV errors can also affect the RDW test results. 

• RDW in conjunction with other blood test parameters 

To fully grasp RDW results, we need to analyse them with other blood parameters, like MCV. This pair may aid healthcare providers in distinguishing anaemia types and planning management. 

• RDW and MCV (Mean Corpuscular Volume) 

Here’s how RDW and MCV connect for correct interpretation of results.  

• High RDW, low MCV suggests: Iron deficiency anaemia, sickle cell, or beta- thalassaemia. 
• High RDW, normal MCV concludes: Initial iron deficiency anaemia, initial B12/folate shortage, or blood loss. 
• High RDW, high MCV hints: Vitamin B12 shortage, folate deficit, or hemolytic anaemia. 
   

Studies have shown that if the blood test reports show RDW value is on the higher side, it may indicate an underlying inflammatory condition and might indicate an increased risk of heart disease.

Dr. Siddharth Gupta, B.A.M.S, M.D

Clinical Applications and Significance of RDW 

In this section, we explore the role of RDW in diagnosing  anaemia, its association with cardiovascular health, inflammatory conditions, cancer, and mortality. 

1. Role of RDW in diagnosing anaemia 

RDW is a handy tool for finding and setting apart anaemia types. By checking changes in red blood cell size and  volume, healthcare providers can point out possible nutrient deficiency and other causes of  anaemia. Also, RDW results can help in picking the best management plan to address the diagnosed  anaemia type. 

2. RDW and cardiovascular health 

A lot of studies have linked high RDW levels with an increased risk of heart disease, heart failure, and heart attacks. More research is needed to find out if high RDW levels could be a useful marker for finding people at higher risk for heart disease. 

3. RDW and inflammatory conditions 

There’s a growing link found between high RDW levels and many inflammatory and autoimmune problems, such as skin rashes, lupus, and rheumatoid arthritis. It’s still not clear if RDW is a cause or an effect of these problems, but its link with disease activity helps its potential use as a diagnostic tool. 

4. RDW and cancer 

Many studies have found links between high RDW levels and an increased risk of getting certain types of cancers. These include blood-related cancers, lung cancer, and colon cancer, among others. Moreover, high RDW levels were tied with a worse outcome in patients with these cancers. More research is needed to see if RDW might serve as a useful indicator of how the patient may fare. 

5. RDW and mortality 

Research hints that high RDW levels are tied to an increased risk of dying from various causes. Checking RDW levels in routine blood tests could give early signs for people at greater risk of death or those in need of preventive care. More research is needed to corroborate the link.  

I recently came across an article suggesting that one metric in complete blood cell counts is red blood cell distribution width (RDW), which has been identified as an inflammatory biomarker. It is well established that inflammatory microenvironments are linked to multiple myeloma (MM). RDW, which reflects systemic inflammation, would be an easy-to-use and readily available biomarker of MM symptoms.

Dr. Rajeev Singh, BAMS

Managing Abnormal RDW Levels 

It’s crucial to take charge of any odd RDW levels as this can enhance patient outcomes. Healthcare providers should aim to find the root of odd RDW levels and take proper steps to manage the condition. 

• How to lower high RDW? 

It depends on its root cause. Depending on the specific reason found, healthcare providers may suggest the following.  

• Eating a diet rich in iron, folate, or vitamin B-12. 
• Kicking the smoking habit  
• Limiting alcohol use 
• Making improvements in everyday life, such as enough sleep and regular exercise. 
• Taking supplements aimed at improving nutrient deficiency (under doctor’s guidance). 
   
   

• Addressing the underlying cause of abnormal RDW 

It’s important to diagnose and manage the root cause of odd RDW levels early to enhance patient outcomes. Advice for handling these root causes will vary based on the specific condition found. Each patient should get a custom management plan, making sure both RDW levels and any health problems are taken care of. 

• Monitoring RDW levels over time 

Regular checks of RDW levels allow healthcare providers to detect changes in your red blood cell health early. By keeping a check on RDW levels over time, doctors can rate how effectively therapy is working, watch disease  fluctuations, and make changes if needed so you get the best possible results. 

Conclusion 

Understanding the importance of RDW in blood tests is key for diagnosing and managing a range of health issues, including different types of  anaemia, and underlying nutrient shortages. By correctly reading RDW results along with other blood test parameters and addressing any abnormal levels, healthcare providers can detect potential health risks and build custom management plans to enhance patient outcomes. Be sure to discuss with your healthcare provider if you are worried about your RDW levels and seek advice on proper steps for managing any identified issues. 

Frequently Asked Questions (FAQs) 

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