Red cell distribution width’s role in differentiating iron deficiency anemia from other hypochromic microcytic anemias

  • Shno Ibrahim Hussein Rapareen Pediatric Hospital, Erbil, Iraq.
  • Abbas Abdulkadir Rabaty Department of Pediatrics, College of Medicine, Hawler Medical University, Erbil, Iraq.
Keywords: RDW, IDA, RBC indices, Microcytic anemia, Serum iron


Background and objective: The red cell distribution width is suggested to be a more sensitive indicator for microcytic hypochromic anemia. Therefore, this study aimed to determine the role of red cell distribution width in the diagnosis of iron deficiency anemia from other causes of hypochromic microcytic anemia.

Methods: This cross-sectional study involved the children patients who attended Rapareen Teaching Hospital in Erbil city in 2019 and were diagnosed with hypochromic microcytic anemia.

Results: The red cell distribution width was determined in a group of 70 children with iron deficiency anemia and 30 cases with a non-iron deficiency (other hypochromic microcytic anemias). Patients with a higher socio-demographic status were more likely to have iron deficiency anemia than those with low socio-demographic status; 82.61% vs. 76.60%, respectively. The patients with symptoms were more likely to be diagnosed with iron deficiency anemia (P = 0.024). The mean red cell distribution width value was 14.38%, 15.73%, and18.02% among mild, moderate, and severely anemic children (P <0.001). Increasing red blood cells (r=-0.271), hemoglobin (r=-0.454), serum iron (r=-0.601), and serum ferritin (r=-0.560) lead to decrease red cell distribution width. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of red cell distribution width in diagnosing iron deficiency anemia in children patients were 77.14%, 63.33%, 83.08%, 54.29%, and 73.0%, respectively.

Conclusions: This study showed that red cell distribution width has good sensitivity and specificity in diagnosing iron deficiency anemia.


Burz C, Cismaru A, Pop V, Bojan A. Iron-Deficiency Anemia. London: Intech Open; 2018.

Vehapoglu A, Ozgurhan G, Demir AD, Uzuner S, Nursoy MA, Turkmen S, et al. Hematological Indices f or Differential Diagnosis of Beta Thalassemia Trait and Iron Deficiency Anemia. Anemia. 2014; 2014:576738.

World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity; 2011. World Health Organization.

Abdul-Fatah BN, Murshid RM, Ahmed TE. Assessment of iron deficiency anemia (IDA) and dietary pattern among pregnant women in Baghdad city, Iraq. J Pharm Sci Res. 2018; 10(9):2279–84.

Choudhary M, Sharma D, Shekhawat DS, Dabi D. Significance of red cell distribution width in the diagnosis of iron deficiency anemia: An observational study from India. J Pediatr Neonatal Care. 2015; 3(1):00102.

Miller JL. Iron deficiency anemia: A common and curable disease. Cold Spring Harbor Lab Press 2013; 3(7):a011866.

Mogahed MM. Abdelwahab SM. Early prediction of iron deficiency in females in child bearing age in central Saudi Arabia. Alexandria Journal of Medicine. 2019; 54:561–6.

Bates I. Reference ranges and normal values. In: Bain BJ, Bates I, Laffan MA, editors. Dacie and Lewis Practical Haematology. Elsevier; 2017. PP8–17.

Purnamasidhi CAW, Suega K, Bakta M. Role of red cell distribution width (RDW) in the diagnosis of iron deficiency anemia. Indonesia J Biomed Sci. 2019; 13(1):12–15.

Sultana GS, Haque SA, Sultana T, Ahmed AN. Value of red cell distribution width (RDW) and RBC indices in the detection of iron deficiency anemia. Mymensingh Med J. 2013; 22(2):370–6.

Sultana GS, Haque SA, Nessa A, Muttalib MA, Rahman Q. Red Cell Distribution Width (RDW) and Hb% in the Detection of Iron Deficiency Anemia in Pregnant Women. AKMMC J. 2018; 9(2):137–41.

Xanthopoulos N, Giamouzis G, Melidonis A, Kitai T, Paraskevopoulou E, Paraskevopoulou P, et al. Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus. Cardiovascular Diabetology. 2017; 16:81.

Li Y, Xing CH, Wei M, Wu H, Hu X, Li S, et al. Combining Red Blood Cell Distribution Width (RDW-CV) and CEA Predict Poor Prognosis for Survival Outcomes in Colorectal Cancer. J Cancer. 2019; 10(5):1162–70.

Salvagno GL, Sanchis-Gomar F, Picanza A, Lipp G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2014; 52(2):86–105.

Aulakh R, Sohi I, Singh T, Kakkar N. Red Cell Distribution Width (RDW) in the Diagnosis of Iron Deficiency with Microcytic Hypochromic Anemia. Indian J Pediatr. 2009; 76:265–8.

Dugdale AE, BadrickT. Red blood cell distribution width (RDW)- a mechanism for normal variation and changes in pathological states. J Lab Precis Med. 2018; 3:73.

Benie T. Red Cell Distribution Width, Revisited. Lab Medicine. 2013; 44(2):e2–9.

United Nations. World Health Organization, Iron Deficiency Anaemia: Assesment, Prevention and Control: a Guide for Programme Managers; 2001. World Health Organization.

Omer W, Al-Hadithi T. Developing a socioeconomic index for health research in Iraq. East Mediterr Health J. 2017; 23(10):670–7.

Aslan D, Gümrük F, Gürgey A, Altay C. Importance of RDW value in differential diagnosis of hypochromeanemias. Am J Hematol. 2002; 69(1):31–3.

Sharma A, Sharma M, Sharma V. Evaluation of red cell distribution width in the diagnosis of iron deficiency anemia. Int J Res Med Sci. 2016; 4(9):3733–6.

Bharati S, Pal M, Chakrabarty S, Bharati P. Socioeconomic determinants of iron-deficiency anemia among children aged 6 to 59 months in India. Asia Pac J Public Health. 2015; 27(2):NP1432–43.

Llanos G, José M, Zamudio G, José L, de los L, Reyes-García MJ. Significance of anaemia in the different stages of life. Enfermería Global. 2016; 15(3):419–30.

Wang M. Iron deficiency and other types of anemia in infants and children. American Family Physician. 2016; 93(4):270–8.

Fareeq ZH, Zangana KO. Influence of iron deficiency anemia on growth: A cross sectional study. Med J Babylon. 2019; 16(4):335–40.

Kamila KH, Mohammad NS. A laboratory study of anemia in children aged 6 months to 6 years in Erbil city. Babylon J. 2014; 11(2):274–84.

Jassim AN. Comparative behavior of red blood cells indices in iron deficiency anemia and β thalassemia trait. Iraqi Journal of Hematology. 2016; 5(2):183–6.

Zhanga Y, Zhang W, WangaSh, Wanga C, Xiea J, Chen X, et al. Detection of human erythrocytes influenced by iron deficiency anemia and thalassemia using atomic force microscopy. Micron. 2012; 43(12):1287–92.

Sirachainan N, Iamsirirak P, Charoenkwan P, Kadegasem P, Wongwerawattanakoon P, Sasanakul W, et al. New mathematical formula for differentiating thalassemia trait and iron deficiency anemia in thalassemia prevalent area: a study in healthy school-age children. Southeast Asian J Trop Med Public Health. 2014; 45(1):174–82.

Nadeem R, Ahmed N, Qureshi GR. Automated measurement of red blood cell microcytosis and hypochromia in iron deficiency and beta thalassemia trait. PJMHS. 2012; 6(1):20–3.

Santosh S, Kushal KK, Ramesh AC. A study on red cell distribution width in relation to other iron (red cell) indices with special reference to reticulocyte count before and after oral iron therapy in iron deficiency anemia. Int J Basic Appl Med Sci. 2013; 3(1): 292–9.

Qureshi NA, Chauhan MAZ, Goswami AP, Suri SK. Study of anemia and its correlation with Hematological parameters in patient of various age group. J Dent Med Sci. 2015; 14(9):29–35.

How to Cite
Hussein, S., & Rabaty, A. (2021). Red cell distribution width’s role in differentiating iron deficiency anemia from other hypochromic microcytic anemias. Zanco Journal of Medical Sciences (Zanco J Med Sci), 25(3), 625-632.
Original Articles