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Journal of Thrombosis and Thrombolysis

, Volume 48, Issue 4, pp 638–647 | Cite as

A narrative review of red blood cell distribution width as a marker for pulmonary embolism

  • Lindsay HammonsEmail author
  • Jason Filopei
  • David Steiger
  • Eric Bondarsky
Article
First Online:

Abstract

Red blood cell distribution width (RDW) is a marker of variability in red blood cell size, and is routinely reported as part of a patient’s complete blood count. RDW has been shown to be associated with the prediction, severity and prognosis of pulmonary embolism (PE) in recent studies. The underlying biomolecular mechanism of the relationship of RDW to PE is largely unknown, but is thought to be due to the relationship of RDW with acute inflammatory markers and variations in blood viscosity. This review substantiates that a high RDW level, defined using either an arbitrary number or according to receiver operator curve statistics, is associated with a higher risk of acute PE, increased severity (massive vs. submassive) of PE and increased mortality in patients with PE. Nevertheless, the comparison of current studies is limited due to the definition of high RDW (each study uses a different RDW cutoff level), the broad range of exclusion criteria and the inclusion of differing modalities used to diagnose a PE (computed tomography angiogram, ventilation-perfusion study, or clinical diagnosis). Despite the above limitations, these studies provide a promising future clinical use for RDW as a marker of PE.

Keywords

Pulmonary embolism (PE) Deep vein thrombosis (DVT) Venous thromboembolism (VTE) Red blood cell distribution width (RDW) Pulmonary embolism severity index (PESI) 
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Notes

Compliance with ethical standards

Disclosures

The authors have no disclosures.

References

  1. 1.
    Stein PD, Beemath A, Olson RE (2005) Trends in the incidence of pulmonary embolism and deep venous thrombosis in hospitalized patients. Am J Cardiol 95(12):1525–1526PubMedGoogle Scholar
  2. 2.
    Dalen JE, Alpert JS (1975) Natural history of pulmonary embolism. Prog Cardiovasc Dis 17(4):259–270PubMedGoogle Scholar
  3. 3.
    Naess IA, Christiansen SC, Romundstad P et al (2007) Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 5(4):692–699PubMedGoogle Scholar
  4. 4.
    Watson T, Shantsila E, Lip GY (2009) Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. Lancet 373(9658):155–166PubMedGoogle Scholar
  5. 5.
    Simel DL, DeLong ER, Feussner JR, Weinberg JB, Crawford J (1988) Erythrocyte anisocytosis: visual inspection of blood films versus automated analysis of red blood cell distribution width. Arch Intern Med 148(4):822–824PubMedGoogle Scholar
  6. 6.
    Marsh WL, Bishop JW, Darcy TP (1987) Evaluation of red cell volume distribution width (RDW). Hematol Pathol 1(2):117–123PubMedGoogle Scholar
  7. 7.
    Patel KV, Mohanty JG, Kanapuru B et al (2013) Association of the red cell distribution width with red blood cell deformability. Adv Exp Med Biol 765:211–216PubMedPubMedCentralGoogle Scholar
  8. 8.
    Lippi GT, Targher G, Montagnana M et al (2009) Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 133(4):628–632PubMedGoogle Scholar
  9. 9.
    Sincer I, Zorlu A, Yilmaz M et al (2012) Relationship between red cell distribution width and right ventricular dysfunction in patients with chronic obstructive pulmonary disease. Heart Lung 41(3):238–243PubMedGoogle Scholar
  10. 10.
    Oh J, Kang SM, Hong N et al (2009) Relation between red cell distribution width with echocardiographic parameters in patients with acute heart failure. J Card Fail 15(6):517–522PubMedGoogle Scholar
  11. 11.
    Tonelli M, Sacks F, Arnold M et al (2008) Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation 117(2):163–168PubMedGoogle Scholar
  12. 12.
    Felker GM, Allen LA, Pocock SJ et al (2007) Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol 50(1):40–47PubMedGoogle Scholar
  13. 13.
    Zorlu A, Bektasoglu G, Guven FM et al (2012) Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol 109(1):128–134PubMedGoogle Scholar
  14. 14.
    Gong YL, Long X, Jin J et al (2017) Elevation of red cell distribution width during hospitalization predicts mortality in patients with sepsis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 29(6):481–485PubMedGoogle Scholar
  15. 15.
    Otero TMN, Canales C, Yeh DD et al (2016) Elevated red cell distribution width at initiation of critical care is associated with mortality in surgical intensive care unit patients. J Crit Care 34:7–11PubMedPubMedCentralGoogle Scholar
  16. 16.
    Makhoul BF, Khourieh A, Kaplan M et al (2013) Relation between changes in red cell distribution width and clinical outcomes in acute decompensated heart failure. Int J Cardiol 167(4):1412–1416PubMedGoogle Scholar
  17. 17.
    Kim CH, Park JT, Kim EJ et al (2013) An increase in red blood cell distribution width from baseline predicts mortality in patients with severe sepsis or septic shock. Crit Care 17(6):R282PubMedPubMedCentralGoogle Scholar
  18. 18.
    Zoller B, Melander O, Svensson P, Engstrom G (2014) Red cell distribution width and risk for venous thromboembolism: a population-based cohort study. Thromb Res 133(3):334–339PubMedGoogle Scholar
  19. 19.
    Yu FT, Armstrong JK, Tripette J, Meiselman HJ, Cloutier G (2011) A local increase in red blood cell aggregation can trigger deep vein thrombosis: evidence based on quantitative cellular ultrasound imaging. J Thromb Haemost 9(3):481–488PubMedPubMedCentralGoogle Scholar
  20. 20.
    Gersh KC, Nagaswami C, Weisel JW (2009) Fibrin network structure and clot mechanical properties are altered by incorporation of erythrocytes. Thromb Haemost 102(6):1169–1175PubMedPubMedCentralGoogle Scholar
  21. 21.
    Celik A, Ozcan IT, Gundes A et al (2015) Usefulness of admission hematologic parameters as diagnostic tools in acute pulmonary embolism. Kaohsiung J Med Sci 31(3):145–149PubMedGoogle Scholar
  22. 22.
    Akgedik R, Karamanli H, Kurt AB, Gunaydin ZY (2018) Usefulness of admission red blood cell distribution width as a predictor of severity of acute pulmonary embolism. Clin Respir J 12(2):786–794PubMedGoogle Scholar
  23. 23.
    Gunay E, Sarinic Ulasli S, Kacar E et al (2014) Can platelet indices predict obstruction level of pulmonary vascular bed in patients with acute pulmonary embolism? Clin Respir J 8(1):33–40PubMedGoogle Scholar
  24. 24.
    Inuzuka R, Abe J (2015) Red blood cell distribution width as a link between ineffective erythropoiesis and chronic inflammation in heart failure. Circ J 79(5):974–975PubMedGoogle Scholar
  25. 25.
    Allen LA, Felker GM, Mehra MR et al (2010) Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail 16(3):230–238PubMedGoogle Scholar
  26. 26.
    Cha MJ, Lee HS, Kim HM et al (2017) Association between red cell distribution width and thromboembolic events in patients with atrial fibrillation. Eur J Intern Med 46:41–46PubMedGoogle Scholar
  27. 27.
    Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G (2015) Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 52(2):86–105PubMedGoogle Scholar
  28. 28.
    Thayer RE, Huang S, Levinson RT et al (2019) Unbiased phenome-wide association studies of red cell distribution width identifies key associations with pulmonary hypertension. Ann Am Thorac Soc.  https://doi.org/10.1513/AnnalsATS.201809-594OC CrossRefPubMedGoogle Scholar
  29. 29.
    Yardan T, Meric M, Kati C, Celenk Y, Atici AG (2016) Mean platelet volume and mean platelet volume/platelet count ratio in risk stratification of pulmonary embolism. Medicina (Kaunas) 52(2):110–115Google Scholar
  30. 30.
    Wells PS, Ginsberg JS, Anderson DR et al (1998) Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 129(12):997–1005PubMedGoogle Scholar
  31. 31.
    Wicki JP, Perrier A, Perneger TV, Bounameaux H, Junod AF (2000) Prediction adverse outcome in patients with acute pulmonary embolism: a risk score. Thromb Haemost 84:548–552PubMedGoogle Scholar
  32. 32.
    Calisir C, Yavas US, Ozkan IR et al (2009) Performance of the Wells and revised Geneva scores for predicting pulmonary embolism. Eur J Emerg Med 16(1):49–52PubMedGoogle Scholar
  33. 33.
    Girardi AM, Bettiol RS, Garcia TS (2018) Wells and Geneva scores are not reliable predictors of pulmonary embolism in critically ill patients: a retrospective study. J Intensive Care Med.  https://doi.org/10.1177/0885066618816280 CrossRefPubMedGoogle Scholar
  34. 34.
    Singh B, Mommer SK, Erwin PJ, Mascarenhas SS, Parsaik AK (2013) Pulmonary embolism rule-out criteria (PERC) in pulmonary embolism–revisited: a systematic review and meta-analysis. Emerg Med J 30(9):701–706PubMedGoogle Scholar
  35. 35.
    Kucher N, Rossi E, DeRosa M, Goldhaber SZ (2006) Massive pulmonary embolism. Circulation 113(4):577–582PubMedGoogle Scholar
  36. 36.
    Aujesky D, Obrosky DS, Stone RA et al (2005) Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 172(8):1041–1046PubMedPubMedCentralGoogle Scholar
  37. 37.
    Secemsky E, Chang Y, Jain CC et al (2018) Contemporary management and outcomes of patients with massive and submassive pulmonary embolism. Am J Med 131(12):1506–1514PubMedGoogle Scholar
  38. 38.
    Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J 29(18):2276–2315PubMedGoogle Scholar
  39. 39.
    Jaff MR, McMurtry MS, Archer SL et al (2011) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123(16):1788–1830PubMedGoogle Scholar
  40. 40.
    Inonu H, Acu B, Pazarli AC et al (2012) The value of the computed tomographic obstruction index in the identification of massive pulmonary thromboembolism. Diagn Interv Radiol 18(3):255–260PubMedGoogle Scholar
  41. 41.
    Sunnetcioglu A, Sertogullarindan B, Ozbay B, Asker S, Ekin S (2015) Assessments of the associations of thrombus localization with accompanying disorders, risk factors, D-dimer levels, and the red cell distribution width in pulmonary embolism. Clinics 70(6):441–445PubMedPubMedCentralGoogle Scholar
  42. 42.
    Bucciarelli P, Maino A, Felicetta I et al (2015) Association between red cell distribution width and risk of venous thromboembolism. Thromb Res 136(3):590–594PubMedGoogle Scholar
  43. 43.
    Rahimtoola A, Bergin JD (2005) Acute pulmonary embolism: an update on diagnosis and management. Curr Probl Cardiol 30(2):61–114PubMedGoogle Scholar
  44. 44.
    Ozsu S, Abul Y, Gunaydin S, Orem A, Ozlu T (2014) Prognostic value of red cell distribution width in patients with pulmonary embolism. Clin Appl Thromb Hemost 20(4):365–370PubMedGoogle Scholar
  45. 45.
    Zhou XY, Chen HL, Ni SS (2017) Red cell distribution width in predicting 30-day mortality in patients with pulmonary embolism. J Crit Care 37:197–201PubMedGoogle Scholar
  46. 46.
    Sen HS, Abakay O, Tanrikulu AC et al (2014) Is a complete blood cell count useful in determining the prognosis of pulmonary embolism? Wien Klin Wochenschr 126(11–12):347–354PubMedGoogle Scholar
  47. 47.
    Yazici S, Kiris T, Sadik Ceylan U et al (2018) Relation between dynamic change of red cell distribution width and 30-day mortality in patients with acute pulmonary embolism. Clin Respir J 12(3):953–960PubMedGoogle Scholar
  48. 48.
    Jurin I, Trkulja V, Ajduk M, Letilović T, Hadžibegović I (2019) Red cell distribution width in acute pulmonary embolism patients: a simple aid for improvement of the 30-day mortality risk stratification based on the pulmonary embolism severity index. Heart Lung.  https://doi.org/10.1016/j.hrtlng.2019.02.006 CrossRefPubMedGoogle Scholar
  49. 49.
    Kheirkham-Sabetghadam S, Jenab Y, Ghoreyshi-Hefzabad SM et al (2018) Association between elevated red blood cell distribution width and long-term mortality in acute pulmonary embolism. Turk J Med Sci 48(2):318–323PubMedGoogle Scholar
  50. 50.
    Yazici S, Siris T, Ceylan US et al (2016) The accuracy of combined use of troponin and red cell distribution width in predicting mortality of patients with acute pulmonary embolism. Wien Klin Wochenschr 128(Suppl 8):596–603PubMedGoogle Scholar
  51. 51.
    Condliffe R, Kiely DG, Gibbs JS (2008) Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med 177(10):1122–1127PubMedGoogle Scholar
  52. 52.
    Witkin AS, Channick RN (2015) Chronic thromboembolic pulmonary hypertension: the end result of pulmonary embolism. Curr Cardiol Rep 17(8):63PubMedGoogle Scholar
  53. 53.
    Abul Y, Ozsu S, Korkmaz A et al (2014) Red cell distribution width: a new predictor for chronic thromboembolic pulmonary hypertension after pulmonary embolism. Chronic Respir Dis 11(2):73–81Google Scholar
  54. 54.
    Wang W, Liu J, Yang YH et al (2016) Red cell distribution width is increased in chronic thromboembolic pulmonary hypertension. Clin Respir J 10(1):54–60PubMedGoogle Scholar
  55. 55.
    Forhecz Z, Gombos T, Borgulya G et al (2009) Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J 158(4):659–666PubMedGoogle Scholar
  56. 56.
    Montagnana M, Cervellin G, Meschi T, Lippi G (2011) The role of red blood cell distribution width in cardiovascular and thrombotic disorders. Clin Chem Lab Med 50(4):635–641PubMedGoogle Scholar
  57. 57.
    Kato H, Inshida J, Imagawa S et al (2005) Enhanced erythropoiesis mediated by activation of the renin-angiotensin system via angiotensin II type 1a receptor. FASEB J 19(14):2023–2025PubMedGoogle Scholar
  58. 58.
    Gossmann J, Burkhardt R, Harder S et al (2001) Angiotensin II infusion increases plasma erythropoietin levels via an angiotensin II type 1 receptor-dependent pathway. Kidney Int 60(1):83–86PubMedGoogle Scholar
  59. 59.
    Jimenez D, Aujesky D, Moores L et al (2010) Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 170(15):1383–1389PubMedGoogle Scholar
  60. 60.
    Konstantinides SV, Torbicki A, Agnelli G et al (2014) 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J.  https://doi.org/10.1093/eurheartj/ehu283 CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Jen WY, Jeon YS, Kojodjojo P (2018) A new model for risk stratification of patients with acute pulmonary embolism. Clin Appl Thromb Hemost.  https://doi.org/10.1177/1076029618808922 CrossRefPubMedPubMedCentralGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineMount Sinai Beth IsraelNew York CityUSA
  2. 2.Division of Pulmonary, Critical Care and Sleep MedicineMount Sinai Beth IsraelNew York CityUSA
  3. 3.Division of Pulmonary, Critical Care and Sleep MedicineNew York UniversityNew York CityUSA

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