| Objective To analyze the distribution characteristics of red blood cell distribution width(RDW)in newly diagnosed myelodysplastic syndromes(MDS),aplastic anemia(AA),acute leukemia(AL)and chronic myeloid leukemia(CML),and to further explore the significance of RDW in the diagnosis and differential diagnosis of newly diagnosed MDS,AA,AL and CML.Methods The clinical data of the patients of newly diagnosed MDS(90 cases),AA(67 cases),AL(102 cases),CML(111 cases)and normal control group(76 cases)were collected from the Department of Hematology of the first hospital of Lanzhou University from 2002 to 2021.Based on the laboratory test reference values of our hospital:RDW-CV(10.9-15.4%)and RDW-SD(39-46f L)as the standard,the patients were divided into low RDW group,normal RDW group and high RDW group.The distribution of RDW values of four diseases were analyzed retrospectively.The relationship between RDW and disease types in AA(non-severe/severe/very severe)and in AL(ALL/AML)was further analyzed.The RDW levels of four diseases and control group were compared and analyzed.The correlation between the prognostic risk stratification of MDS,AML(except APL)and RDW was explored.Result1.General information:The median age of the normal control group is 64 years old(17-85 years),including 28 males(36.8%)and 48 females(63.2%).The median age of MDS group is 56.5 years old(2-84 years),including 49 males(54.4%)and 41 females(45.6%).The median age of AA group is 28 years old(2-82 years),including 39 males(58.2%)and 28 females(41.8%).The median age of AL group is 48 years old(2-78years),including 61 males(59.8%)and 41 females(40.2%);among them,the median age of AML is 51 years old(3-78 years)and the median age of ALL is 13 years old(2-72 years).The median age of CML group is 45 years old(2-83 years),including 63males(56.8%)and 48 females(43.2%).The proportion of male in MDS,AA,AL and CML is higher than that of female.There is no statistical difference in the distribution of males and females between MDS,AA,AL,and CML(χ~2=0.597,P=0.897).2.There are 53 cases of MDS-MLD(58.9%),14 cases of MDS-EB-2(15.6%),13cases of MDS-EB-1(14.4%),5 cases of MDS-RS-MLD(5.6%),2 cases of MDS-SLD(2.2%),1 case of MDS-RS-SLD,1 case of MDS-U and 1 case of MDS with del(5q).There are 27 cases(40.3%)of non-severe AA,31 cases(46.3%)of severe AA and 9cases(13.4%)of very severe AA.In AL,there are 29 cases of ALL(28.4%),21 cases of AML-M4(20.6%),20 cases of AML-M2(19.6%),15 cases of AML-M5(14.7%),14cases of AML-M3(13.7%)and 3 cases of AML-M1(2.9%).All 111 cases of CML are in CP phase.3.RDW value distribution of MDS,AA,AL,CML:(1)In MDS,AA,AL,CML patients,the high RDW-CV are respectively 72 cases(80%),30 cases(44.8%),71 cases(69.6%),105 cases(94.6%),the normal RDW-CV are respectively 18 cases(20%),37 cases(55.2%),31 cases(30.4%),6 cases(5.4%),the low RDW-CV are all 0 cases.Compared with the control group,the RDW-CV of MDS,AA,AL,and CML are all increased(χ~2 are respectively 103.546,39.612,84.321,159.865,and the P values are all 0.000).(2)In MDS,AA,AL,CML patients,the high RDW-SD are respectively 88 cases(97.8%),45 cases(67.2%),94 cases(92.2%),111 cases(100%),the normal RDW-SD are respectively 2 cases(2.2%),15 cases(22.4%),8 cases(7.8%),0 cases,low RDW-SD are respectively 0 cases,7 cases(10.4%),0 cases,0 cases.Compared with the control group,the RDW-SD of MDS,AA,AL,and CML are all increased(χ~2 are respectively 100.808,47.196,90.366,125.891,and the P values are all 0.000).4.The relationship between AA(non-severe/severe/very severe)and AL(ALL/AML)disease types and RDW:(1)The RDW-CV levels of non-severe,severe,and very severe in AA are respectively 15.30±2.06%,15.57±2.31%,13.43±1.33%,and RDW-SD levels are respectively 56.54±11.67f L,53.58±11.25f L,42.26±6.34f L,the differences in RDW-CV and RDW-SD levels among the three groups are statistically significant(F are respectively 3.676 and 5.779,and P values are respectively 0.031 and 0.005).The RDW-CV of non-severe and severe is higher than that of very severe(P values are0.024 and 0.009 respectively).The RDW-SD of non-severe and severe is higher than that of very severe(P values are 0.001 and 0.008 respectively).(2)In AL,the RDW-CV levels of ALL and AML patients are respectively17.53±2.61%and 16.66±2.79%,and the RDW-SD levels are respectively58.28±11.56f L and 59.67±10.33f L.There are no statistically significant differences in the RDW-CV and RDW-SD levels between the two groups(P values are 0.148 and0.554 respectively).5.Comparison of RDW levels of MDS,AA,AL,CML with the control group:(1)The RDW-CV levels of patients with MDS,AA,AL,and CML are18.19±3.14%,15.18±2.19%,16.90±2.76%,18.32±2.02%,which are significantly higher than those of the normal control group of 13.29±0.85%.,and the difference is statistically significant(P values are all 0.000).(2)The RDW-SD levels of patients with MDS,AA,AL,and CML are67.70±11.63f L,53.25±11.71f L,59.27±10.65f L,60.64±6.32f L,which are significantly higher than those of the normal control group of 44.53±3.08f L,and the difference is statistically significant(P values are all 0.000).6.Comparison of RDW level among MDS,AA,AL,CML:(1)The RDW-CV levels of the MDS,AL,and CML groups are respectively18.19±3.14%,16.90±2.76%,18.32±2.02%,which are all higher than 15.18±2.19%in the AA group,and the P values are all 0.000.The RDW-CV of the MDS and CML groups are higher than those of the AL group,and the P values are 0.003 and 0.000,respectively.(2)The RDW-SD levels of the MDS,AL,and CML groups are 67.70±11.63f L,59.27±10.65f L,60.64±6.32f L,which are all higher than 53.25±11.71f L in the AA group,and the P values are 0.000,0.001,0.000,respectively.The RDW-SD of the MDS group is higher than that of the AL and CML groups,and the P value are both 0.000.7.The correlation between the prognostic risk stratification of MDS and AML(except APL)and RDW:(1)In MDS,there are 82 cases with prognostic risk stratification(IPSS score):6cases(7.3%)of low risk,60 cases(73.2%)of intermediate risk-1,and 14 cases of intermediate risk-2(17.1%)),2 cases(2.4%)of high-risk.The RDW-CV levels of low-risk,intermediate-risk-1,intermediate-risk-2,and high-risk patients are 17.55±4.02%,18.27±2.96%,17.24±3.52%,17.35±2.62%,and RDW-SD levels are 64.72±10.14f L,68.56±11.68f L,64.41±12.86f L,68.65±1.34f L,there is no statistically significant difference in the levels of RDW-CV and RDW-SD among the four risk stratification groups(F values are respectively 0.488 and 0.607,and P values are respectively 0.691and 0.612).There is no correlation between MDS prognostic risk stratification and RDW.(2)In AML(except APL),there are 38 cases with prognostic risk stratification:9cases(23.6%)with good prognosis,8 cases(21.1%)with moderate prognosis,and 21cases(55.3%)with poor prognosis.The RDW-CV levels with good,moderate,and poor prognosis are 16.77±2.17%,15.40±2.11%,17.37±3.51%,and the RDW-SD levels are59.44±8.36f L,58.01±7.55f L,62.78±9.63f L,respectively.There is no statistically significant difference in the levels of RDW-CV and RDW-SD between the groups of risk stratification(F values are 1.247 and 0.994,and P values are 0.300 and 0.380,respectively).There is no correlation between AML(except APL)prognostic risk stratification and RDW.In conclusion1.The RDW-CV and RDW-SD levels of MDS,AA,AL,CML increased.2.The levels of RDW-CV and RDW-SD of non-severe and severe AA are higher than those of very severe AA.3.Although the RDW-CV and RDW-SD levels of AL(ALL,AML)are increased,there is no difference in the levels of RDW-CV and RDW-SD between ALL and AML.4.The RDW-CV and RDW-SD of MDS,AL and CML are all higher than AA.The RDW-CV of MDS and CML are higher than AL.The RDW-SD of MDS is higher than that of AL and CML.5.The prognostic risk stratification of MDS and AML(except APL)has nothing to do with the RDW value. |
PDF Full Text Request