From the Research
RDW in anemia of chronic disease is typically normal or mildly elevated, with values ranging from 11.5% to 14.5%. This is because anemia of chronic disease often produces red blood cells that are relatively uniform in size, resulting in a normal or slightly elevated RDW. The underlying mechanism involves reduced erythropoietin production and impaired iron utilization, rather than defective red cell production, which is different from iron deficiency anemia where RDW is typically more significantly elevated due to the production of cells of varying sizes 1.
Key Points to Consider
- RDW measures the variation in red blood cell size, with normal values ranging from 11.5% to 14.5% 1.
- Anemia of chronic disease often produces red blood cells that are relatively uniform in size, resulting in a normal or slightly elevated RDW.
- The relatively normal RDW in anemia of chronic disease occurs because the underlying mechanism involves reduced erythropoietin production and impaired iron utilization, rather than defective red cell production 2.
- This finding, combined with other laboratory values such as normal or elevated ferritin levels and low transferrin saturation, helps differentiate anemia of chronic disease from other types of anemia, particularly iron deficiency anemia.
Clinical Implications
- An increased RDW has a high negative predictive value for diagnosing a variety of disorders and conveys important information for short- and long-term prognosis 1.
- The value of RDW is now being regarded as a strong and independent risk factor for death in the general population.
- An increased RDW mirrors a profound deregulation of erythrocyte homeostasis involving both impaired erythropoiesis and abnormal red blood cell survival, which may be attributed to a variety of underlying metabolic abnormalities 1.
Management and Treatment
- The current standard of care for anemia of chronic disease includes oral or intravenous iron supplementation, erythropoiesis-stimulating agents, and red blood cell transfusion 3.
- However, each of these therapies has its own set of population-specific patient concerns, including increased risk of cardiovascular disease, thrombosis, and mortality.
- Novel therapies, including hypoxia-inducible factor prolyl hydroxylase inhibitors and hepcidin inhibitors/antagonists, have shown promise in attenuating the levels and/or activity of hepcidin in anemia of CKD, thus ensuring the availability of iron for erythropoiesis 2.