Dr. Ron’s Research Review – May 9, 2012

This week’s research review focuses on celiac disease and RDW.

One study found that elevated red cell distribution width was the most frequent abnormality, being present in 57.9% of adult untreated celiac patients (Chi square analysis, p<0.01 versus other laboratory changes). (Brusco, Di Stefano et al. 2000)

Another study found that RDW was increased in 94 (47.4%) and normal in 104 (52.5%) of 198 patients in whom clinical suspicion of celiac disease was strong and were referred for further investigations and intestinal biopsy.. Duodenal biopsy confirmed coeliac disease in 80 (85.1%) of the former patients and 69 (66.3%) of the latter patients. No correlation between RDW values and histological scores was found. Overall RDW increase was found in 80/149 (53.7%) patients with a definite diagnosis of coeliac disease, and in 14/49 (28.6%) patients in whom biopsy excluded the disease. A 1-year gluten withdrawal led to a significant decrease in RDW value, even in patients with obdurate mucosal impairment. (Sategna Guidetti, Scaglione et al. 2002)

Dr. Ron


Articles

Increased red cell distribution width and coeliac disease

            (Brusco, Di Stefano et al. 2000) Download

BACKGROUND/AIMS: Despite availability of sensitive screening tests, coeliac disease is still underdiagnosed. To determine which haematochemical abnormalities might be more predictive of this condition, we reviewed the clinical records of our series of adult patients affected by coeliac disease. METHODS: Six haematochemical parameters (haemoglobin, red cell distribution width, serum levels of iron, albumin, calcium and potassium) were evaluated in 126 consecutive adult untreated coeliac patients diagnosed since 1990. RESULTS: Elevated red cell distribution width was the most frequent haematochemical abnormality, being present in 57.9% of our patients (Chi square analysis, p<0.01 versus other laboratory changes). CONCLUSION: The increase of red cell distribution width was more common than iron-deficiency anaemia, a well-known indicator of coeliac disease. Elevated red cell distribution width can thus be considered a new predictor of coeliac disease and in the presence of this a search should be made for antiendomysial antibodies.

                 

Red cell distribution width as a marker of coeliac disease: a prospective study

            (Sategna Guidetti, Scaglione et al. 2002) Download

BACKGROUND: Coeliac disease is frequently underdiagnosed because of its protean presentations. Serological tests may be helpful in screening programmes for populations at risk, but they are costly. AIM: To determine prospectively whether a commonly available haematological test such as the red cell distribution width (RDW) could be of help in detecting unrecognized coeliac disease. METHODS: Of 353 consecutive adult patients referred to our outpatient malabsorption clinic, 198 in whom clinical suspicion was strong were referred for further investigations and intestinal biopsy. Seventy-six inflammatory bowel disease outpatients and 90 subjects admitted for diseases other than malabsorption were enrolled as the control group. RESULTS: RDW was increased in 94 (47.4%) and normal in 104 (52.5%) of 198 patients. Duodenal biopsy confirmed coeliac disease in 80 (85.1%) of the former patients and 69 (66.3%) of the latter patients. No correlation between RDW values and histological scores was found. Overall RDW increase was found in 80/149 (53.7%) patients with a definite diagnosis of coeliac disease, and in 14/49 (28.6%) patients in whom biopsy excluded the disease. A 1-year gluten withdrawal led to a significant decrease in RDW value, even in patients with obdurate mucosal impairment. CONCLUSIONS: In patients in whom there is a strong clinical suspicion of coeliac disease, an elevated RDW despite normal haemoglobin concentration may be a reliable predictor of the disease.

References

Brusco, G., M. Di Stefano, et al. (2000). "Increased red cell distribution width and coeliac disease." Dig Liver Dis 32(2): 128-30.

Sategna Guidetti, C., N. Scaglione, et al. (2002). "Red cell distribution width as a marker of coeliac disease: a prospective study." Eur J Gastroenterol Hepatol 14(2): 177-81.