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적혈구 용적 분포폭치 (RDW)의 임상적 고찰

Other Titles
 Clinical evaluation of red cell volume distribution width 
Authors
 박국인 
Department
 Dept. of Pediatrics (소아청소년과학교실) 
Issue Date
1986
Description
의학과/석사
Abstract
[한글]

적혈구 크기의 다양함, 즉 부동적혈구증(anisocytosis)은 변형적혈구증과 더불어 여러 빈혈성 질환에 있어서 형태적인 특징으로 인식되어 왔으나, 적혈구 크기의 전통적인 현미경상 측정은 신속함과 정확성 및 객관성에 있어서 많은 제약이 있었다.

최근 새롭게 개발된 혈액자동분석기의 일종의 Coulter Counter Model S-plus Ⅱ,Ⅲ**(R) (Coulter Electronics, Hialeah, FL) 도입으로 적혈구 크기의 불균질성 (hetero geneity), 즉 부동적혈구증의 양적인 측정이 적혈구 용적분포의 변이계수(coefficient of variation : 이하 CV )로서 계산되는 적혈구 용적 분포폭(red cell volume distribution width : 이하 RDW)치로 손쉽게 표기되었다.

이에 저자들은 정상한국 성인과 신생아 및 소아군의 RDW 평균치를 설정함과 동시에 소아과 영역의 각종 빈혈증 및 혈액질환에서의 RDW치는 변동을 평가해 보고 빈혈증의 새로운 분류에 적용하여 그 임상적 유용성을 검토한 바, 다음과 같은 결과를 얻었다.

1. 정상 성인의 RDW치는 12.3±0.8%(mean±S.D.)였으며 남녀별 차이는 없었다(P < 0.05).

2. 정상 신생아의 RDW치는 17.1±1.7%이었고 생후 1, 3, 6, 8, 15, 18개월 및 4세 소아의 RDW치는 각각 14.7±1.0, 12.5±0.8, 13.0±1.0, 12.9±0.7, 13.1±0.8, 12.5±0.6%였으며 신생아를 제외한 정상 소아군의 RDW치는 13.0±1.0%였다.

3. 철결핍성빈혈 및 회복기의 철결핍성 빈혈에서 RDW치는 증가하였고, 초기결핍성빈혈에서 혈액소 및 평균 적혈구 용적(mean corpuscular volume : 이하 MCV)은 정상이었으나 RDW치는 증가하여 조기 발견에 도움을 주었다.

4. RDW치는 망상적혈구율이 증가할수록 높아지는 비례관계를 보였다(r=0.56, P<0.01).

5. 각종 혈액질환 환아 395례를 대상으로 조사한 바 RDW치가 정상인 예는 만성질환에 동반된 빈혈, 급성출혈, 지난 4개월간 수혈을 받지 않은 재생불량성빈혈 등이며, RDW치가 증가된 예는 면역용혈성빈혈, 선천성구상적혈구증, 기계적용혈성빈혈, 만성골수성백혈병, 급성임파구성 및 비임파구성백혈병, 화학요법중인 각종 고형성종양 및 악성임파종, 만성간담도질환에 동반된 빈혈등 이었다.

6. 화학요법중인 급성임파구성 및 비임파구성백혈병에서는 대적혈구증(macrocytosis)이 동반된 경우 정상적혈구증(mormocytosis)일 때 보다 RDW치가 더 증가되어 있었다.

7. 초기 말초혈액 분석을 통한 진단에 도움을 주기위해 산출된 MCV 및 RDW를 기초로 빈혈증과 철결핍성빈혈과의 감별에 도움이 되었다.

8. 채혈후 검사 때까지의 지연시간에 따른 RDW치의 변화는 관찰되지 않았다.

이상과 같은 연구결과를 종합하면, RDW치는 여러 혈액질환에서 증가 혹은 정상이어서 부동적혈구증을 좀더 정확하게 양적으로 측정할 수 있는 지수가 된다. 또한 MCV 및 RDW를 기초를 하여 빈혈증을 새롭게 분류해 볼 수 있어 초기 말초혈액 분석을 통한 진단에 도움이 될 것으로 사료되며, 특히 만성질환에 동반된 빈혈과 철결핍성 빈혈의 감별 및 초기철결핍성빈혈의 조기 발견에 유용한 것으로 생각되는 바이다.



[영문]

Red blood cell size variation (anisocytosis), along with poikilocytosis, have long been recognized as morphologic hallmarks of some amemias. But traditionally, microscopic assessment of anisocytosis had many limitations in speed, precision, and objectivity.

Recently, an automaed blood analyzer, Coulter Counter Model S-Plus Ⅱ, Ⅲ**(R) was introduced and the distribution of red cell volume was displayed in histogram.

Measured as codfficient of variation (CV) and reported as red cell volume distribution width (RDW), the heterogeneity of distribution of red cell size (the equivalent of anisocytosis in analysis of the peripheral blood smear) now forms part of the reported automated blood count.

Therefore, this study was planned to evaluate the clinical significance of RDW by determining the RDW of healthy adults, newborns, and children. Observation was also made on the RDW of pediatric patients with various hematologic diseases and we

evaluated how RDW complements the MCV to improve the classification of anemias from the blood count alone.

The following results were obtained.

1. The mean value of RDW in healthy adults was 12.3±0.8%.

No difference was noted by sex.

2. The mean values of RDW in healthy newborns, 1, 3, 6, 8, 15, 18, and 48 months old children were respectively 17.1±1.7, 14.7±1.0, 12.3±0.8, 13.1±0.9, 13.±1.0, 12.9±0.7, 13.1±0.8, and 12.5±0.6%.

The mean value of RDW in healthy children except newborns was 13.0±1.0%.

3. Increases in RDW have been observed in iron deficient patients and in therapy of iron deficiency, as did those with early iron deficency, even if both MCV and hemoglobin were in the normal range.

4. It was found that the RDW was proportional to the % reticulocyte.

5. Patients with chronic disease, acute hemorrhage, and aplastic anemia with no transfusion in the previous four months had a normal RDW.

On the contrary, patients with immune hemolytic anemia, hereditary spherocytosis, mechanical hemolytic anemia, chronic myelocytic leukemia, chronic hepatobiliary disease, acute lymphocytic leukemia and acute nonlymphocytic leukemia had a high

RDW, as did those with solid tumors and malignant lymphomas during chemotherapy.

6. Among patients with acute lymphocytic and nonlymphocytic leukemia during chemotherapy, RDW was more increased if accompanied by macrocytosis than by mormocytosis.

7. We have developed a classification of anemias, based on MCV and RDW, to guide diagnosis from the peripheral blood analysis. From which, the distinction of iron deficiency anemia from the anemia of chronic disease is improved.

8. The change of RDW which was measured on different interval after collection was studied with anticoagulated (EDTA) blood obtained from 10 normal subjects. The change of RDW according to the storage time was not observed.

From these studies, it can be concluded that the RDW in high of normal in many disease conditions, so it can be used as a sensitive parameter of red cell anisocytosis. Therefore, we have developed a clasification of anemias, based on MCV and RDW, to guide diagnosis from the peripheral blood analysis. Especially, the distinction of ironcy anemia from the anemia of chronic disease and the detection of early iron deficiency is improved.
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https://ymlib.yonsei.ac.kr/catalog/search/book-detail/?cid=CAT000000007115
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 2. Thesis
Yonsei Authors
Park, Kook In(박국인) ORCID logo https://orcid.org/0000-0001-8499-9293
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/115800
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