Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2017; 23(27): 4879-4891
Published online Jul 21, 2017. doi: 10.3748/wjg.v23.i27.4879
Prognostic significance of red blood cell distribution width in gastrointestinal disorders
Hemant Goyal, Giuseppe Lippi, Altin Gjymishka, Bijo John, Rajiv Chhabra, Elizabeth May
Hemant Goyal, Altin Gjymishka, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA 31201, United States
Giuseppe Lippi, Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy
Bijo John, Texas Digestive Disease Consultants, San Antonio, TX 78215, United States
Rajiv Chhabra, Department of Gastroenterology, Saint Luke's Hospital, School of Medicine, University of Missouri Kansas City, Kansas City, MO 64111, United States
Elizabeth May, Gastroenterology Attending, McLaren Northern Hospital, Petoskey, MI 49770, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Hemant Goyal, MD, FACP, Department of Internal Medicine, Mercer University School of Medicine, 707 Pine Street, Macon, GA 31201, United States.
Telephone: +1-478-3015862 Fax: +1-478-3015841
Received: February 28, 2017
Peer-review started: February 28, 2017
First decision: April 26, 2017
Revised: May 2, 2017
Accepted: June 9, 2017
Article in press: June 12, 2017
Published online: July 21, 2017

The red blood cell distribution width (RDW) is a routinely measured and automatically reported blood parameter, which reflects the degree of anisocytosis. Recently, the baseline RDW was found to have clinical significance for assessing clinical outcome and severity of various pathological conditions including cardiovascular diseases, sepsis, cancers, leukemia, renal dysfunction and respiratory diseases. A myriad of factors, most of which ill-defined, have an impact on the red cell population dynamics (i.e., production, maturation and turnover). A delay in the red blood cell clearance in pathological conditions represents one of the leading determinants of increased anisocytosis. Further study of RDW may reveal new insight into inflammation mechanisms. In this review, we specifically discuss the current literature about the association of RDW in various disease conditions involving the gastrointestinal and hepatobiliary systems. We also present some of the related measurements for their value in predicting clinical outcomes in such conditions. According to our data, RDW was found to be a valuable prognostic index in gastrointestinal disorders along with additional inflammatory biomarkers (i.e., C reactive protein, erythrocyte sedimentation rate, and platelet count) and current disease severity indices used in clinical practice.

Keywords: Red blood cell distribution width, Hepatitis, Pancreatitis, Inflammatory bowel diseases, Crohn’s disease, Ulcerative colitis, Colon cancer, Hepatocellular carcinoma, Acute mesenteric ischemia, Gastrointestinal diseases

Core tip: Mounting evidences show that red blood cell distribution width can be used as a prognostic marker in gastrointestinal disorders. A number of retrospective studies have been published about the use of this index of anisocytosis in prognostication of gastrointestinal disorders, especially inflammatory bowel disease and viral hepatitis among others. However, only a few have included confounding factors which could affect red blood cell distribution width. Our objective is to consolidate the current literature to better understand the use and further investigate the significance of red blood cell distribution width in gastrointestinal disorders.