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Interpretation of Red Blood Cell Indices by the Nonhematologist

Interpretation of Red Blood Cell Indices by the Nonhematologist Abstract To the Editor. —The message of the article by Hansen et al1 and Howe's2 accompanying editorial in the January issue of the Archives is sobering. During the last decade, not only have electronic counters made the traditional red blood cell counts and indices more reliable for detecting iron deficiency and thalassemia3,4 but new indices, such as the red blood cell distribution width (RDW), are now widely available. The RDW improves the distinction between iron deficiency and heterozygous thalassemia when mean corpuscular volume (MCV) is low5-7 and between iron-deficient and normal subjects when MCV is normal.8 However, in view of the data of Hansen et al, it is unlikely that physicians who do not use the long-established MCV will do much better with the additional information given by the RDW. We share the view that the diagnostic approach to microcytic anemias needs to be improved.Incidentally, References 1. Hansen RM, Hanson G, Anderson T: Failure to suspect and diagnose thalassemic syndromes: Interpretation of RBC indices by the nonhematologist. Arch Intern Med 1985;145:93-94.Crossref 2. Howe RB: Are 'indexes' an index of physician performance? Arch Intern Med 1985;145:46.Crossref 3. Bessman JD: Microcytic polycythemia: Frequency of non-thalassemic causes. JAMA 1977; 238:2391-2392.Crossref 4. Steinberg MH, Dreiling BJ: Microcytosis: Its significance and evaluation. JAMA 1983;249: 85-87.Crossref 5. Bessman JD, Feinstein DI: Quantitative anisocytosis as a discriminant between iron deficiency and thalassemia minor. Blood 1979;46: 339-346. 6. Kaye F, Alter BP: Red cell size distribution analysis: A non-invasive evaluation of microcytosis, abstracted. Blood 1982;60( (suppl) ):36A. 7. Johnson CS, Tegos C, Beutler E: Thalassemia minor: Routine erythrocyte measurements and differentiation from iron deficiency. Am J Clin Pathol 1983;80:31-36. 8. McClure S, Custer E, Bessman JD: Toward optimal laboratory use: Improved detection of early iron deficiency. JAMA 1985;253:1021-1023.Crossref 9. Williams WJ: Hematology , ed 3. New York, McGraw-Hill Book Co, 1983, p 476. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Interpretation of Red Blood Cell Indices by the Nonhematologist

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Interpretation of Red Blood Cell Indices by the Nonhematologist

Abstract

Abstract To the Editor. —The message of the article by Hansen et al1 and Howe's2 accompanying editorial in the January issue of the Archives is sobering. During the last decade, not only have electronic counters made the traditional red blood cell counts and indices more reliable for detecting iron deficiency and thalassemia3,4 but new indices, such as the red blood cell distribution width (RDW), are now widely available. The RDW improves the distinction between iron deficiency and...
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References (10)

Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1985.00360080217041
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor. —The message of the article by Hansen et al1 and Howe's2 accompanying editorial in the January issue of the Archives is sobering. During the last decade, not only have electronic counters made the traditional red blood cell counts and indices more reliable for detecting iron deficiency and thalassemia3,4 but new indices, such as the red blood cell distribution width (RDW), are now widely available. The RDW improves the distinction between iron deficiency and heterozygous thalassemia when mean corpuscular volume (MCV) is low5-7 and between iron-deficient and normal subjects when MCV is normal.8 However, in view of the data of Hansen et al, it is unlikely that physicians who do not use the long-established MCV will do much better with the additional information given by the RDW. We share the view that the diagnostic approach to microcytic anemias needs to be improved.Incidentally, References 1. Hansen RM, Hanson G, Anderson T: Failure to suspect and diagnose thalassemic syndromes: Interpretation of RBC indices by the nonhematologist. Arch Intern Med 1985;145:93-94.Crossref 2. Howe RB: Are 'indexes' an index of physician performance? Arch Intern Med 1985;145:46.Crossref 3. Bessman JD: Microcytic polycythemia: Frequency of non-thalassemic causes. JAMA 1977; 238:2391-2392.Crossref 4. Steinberg MH, Dreiling BJ: Microcytosis: Its significance and evaluation. JAMA 1983;249: 85-87.Crossref 5. Bessman JD, Feinstein DI: Quantitative anisocytosis as a discriminant between iron deficiency and thalassemia minor. Blood 1979;46: 339-346. 6. Kaye F, Alter BP: Red cell size distribution analysis: A non-invasive evaluation of microcytosis, abstracted. Blood 1982;60( (suppl) ):36A. 7. Johnson CS, Tegos C, Beutler E: Thalassemia minor: Routine erythrocyte measurements and differentiation from iron deficiency. Am J Clin Pathol 1983;80:31-36. 8. McClure S, Custer E, Bessman JD: Toward optimal laboratory use: Improved detection of early iron deficiency. JAMA 1985;253:1021-1023.Crossref 9. Williams WJ: Hematology , ed 3. New York, McGraw-Hill Book Co, 1983, p 476.

Journal

Archives of Internal Medicine – American Medical Association

Published: Aug 1, 1985

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