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RDW Values-in CML and now in Covid

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Hi All,

Having just seen some media reports that following work undertaken at Massachusetts General Hospital RDW is highly correlated with patient mortality in Covid 19 I was curious to check whether we as CML patients are prone to suffer higher scores than normal in terms of Red Cell Distribution Width (RDW) that is firstly  irrespective of Covid , and secondly the risks if we were unfortunate enough to contract the virus.

I note that there was was a previous thread here on forum regarding CML and RDW.

There is some evidence from journal articles that CML patients in many cases experience higher RDW scores than normal and also that this contributes to the possibility to predict likely response and treatment outcomes-higher than normal scores might lead to a less than perfect response to a tki  or the greater likelihood of some  greater resistance.

RDW is a measurement of the range in the volume and size of your red blood cells and if like me you check your scores (see Full Blood Count) on a regular basis the range is as a % from 11.5  to 15-a week ago my tests show a score of 12.9 so well within range.

The Massachusetts researchers concluded that values above the normal range are useful markers and  mean that Covid sufferers have X 3  likelihood to die and indicate the need for treatment paths and perhaps very early intervention-the biological basis of this risk is not yet fully understood. As a patient my own view is that because of CML if I were to have a higher than usual (compared to general population) RDW score then I would be at substantial risk if I were affected by the virus.

There is a condition called macrocytic aneamia where the production of normal red cells is lacking and/or the cells produced are larger than normal and a high RDW might indicate a nutrient deficiency of iron,folates and Vitamin B12. My overall red cell count is a little below range and MCV and MCH a little above ranges but my specialist says no need for concern as we are on the margins.

I take an occasional daily shot of liquid iron and also a Vitamin B complex for the folates as I do not eat  a lot of red meats.

Does anyone else have any issues with their RDW score or any of the other FBC markers such as MCV and MCH and have you discussed with your specialist ?

Best wishes

John

Hello John

I may very well be in the same position as you with anaemia.

My RDW is within range.

My consultant tells me that she concentrates normally upon four markers: haemoglobin, white blood count, neutrophils and platelets.

Based upon haemoglobin of 118 [130-162] she noted that I was "mildly anaemic". She tested for B12, folate and iron and all of these were normal. She recorded that I was norochromic normocytic anaemic.

More recently, my GP has carried out tests and notes that my MCV is 107.6 [83-103], i.e. just above the normal range. His written to my haematologist noting that I am "macrocytic". I will need to discuss this with my haematologist during my forthcoming consultation but my expectation is that she will be unalarmed.

Thanks for the reply and your data.

I have come across reports that use of imatinib might lead to less red cell production and modification to some of the specific counts that we have discussed such as MCV, MCH as well as RDW which in turn leads to lack of oxygenation of the blood and fatigue as a major symptom;in extreme cases growth factors are administered or transfusions.There seems to be little data on the causes and development of anaemia after long term treatment for CMl using tkis and specifically imatinib. In terms of side effects apparently the incidence of Grade 3-4 anaemia is not so high  at about 3% but have not seen a figure for the lower grade effects.

I guess that we can do a number of things in terms of response.We can put in place a strategy to deal with fatigue such as mild exercise and life style responses.We can take supplements and we can pay attention to diet -on this we are recommended to take leafy greens,meat and poultry,liver,seafood and fish,beans nuts/seeds for example. In addition vitamin C levels are important for our ability to absorb heme irons found in meat and non-heme in cereals,beans,some fruits and vegetables.

On one of my key points we might hear more from researchers in the future of the importance of RDW within a Covid context

Regards

John

I have always high RDW and even after 37 months my Pcr 0.126%(IS).so I can correlate the link between high RDW & high Pcr,and difficult to reach Mmr. I will be happy if anyone can shed more light on high RDW & difficulty in reaching Mmr. Waiting for fellow members response.

Higher levels of RDW (and low levels of haemoglobin) might be associated with Thalassemia. As such genetic condition also increases the ferritin levels, usually it is not recommended iron supplementation.