RDW异常282例临床分析

探讨RDW异常的原因，分级及其临床意义，方法：用美国产雅培CD－1700型全自动血球记数仪测定282例各组疾病的RDW、MCV、HGB，同期测定100例健康儿童的RDW、MCV、HGB；并根据RDW值的大小分四组，分别是：RDW降低组、RDW正常组，轻度升高组，重度升高组。结果：100例健康儿童RDW降低组2例，正常组98例；282病例中RDW降低组（＜12％）1例，RDW正常组（12％－14．9％）17例，轻度升高组（15％－27．3％）230例，重度升高（≥27．4％）34例；各疾病观察组RDW均高于健康对照组（P＜0．001）。结论：轻度地中海贫血、缺铁性贫血，炎症及新生儿RDW均可轻度升高，地中海贫血RDW与贫血程度呈负相关；急性溶血性贫血RDW与贫血程度无明显相关。     

MCV/RDW参数对地中海贫血及铁缺乏症筛查应用

近年来血液自动分析仪普及应用,国内外对红细胞平均体积/红细胞体积分布宽度(MCV/RDW)诊断铁缺乏症已有报导,而有关地中海贫血(下称地贫)MCV/RDW的改变及临床应用报道尚少,本文收集近年在我们门诊及住院已明确诊断的61例地贫,68例铁缺乏症(贫血型IDA34例,非贫血型IDE34例),进行MCV/RDW检测同时对104例健康人对比检测,报道如下:材料和方法1.仪器:美国ABBOTTCELLDYN3500型自动血液分析仪,每周用生产厂家的标准校正1次,增使用原生产厂家试剂。2.方法:抽取静脉血0.5ml,用EDTA二钾1.5mg/ml抗凝,2小时内检测完毕。3.检测对象:本…     

缺铁性贫血患儿血小板数和血小板平均容积的变化

探讨缺铁性贫血（IDA）患儿血小板数（PLT）和血小板平均容积（MPV）的变化。方法：采用Cell－DYN1700型血细胞分析仪对32例IDA和22例ID患儿治疗前及其铁剂治疗30天后进行PLT和MPV测定。结果：IDA、ID患儿治疗后PLT为226．6→、283．2、252．3→274．5×109／L，MPV为6．80→7．70、7．72→7．53fl。IDA患儿PLT、MPV明显低于健康对照组（PLT：281．9±87．6×109／L，MPV：7．67±1．12fl）；铁剂治疗前后比较均有显著差异（P均＜0．01）。结论：IDA患儿PLT减少、MPV降低与机体铁缺乏有关。     

缺铁性贫血与微量元素铅、锌、铜等的关系

缺铁性贫血（IDA）与铅、锌、铜等微量元素的关系报道较少，为此，我们于1991年5月至1992年3月对我院门诊及住院患儿以及成人患者共111例进行观察，现报道如下。对＠和六法n月～13岁71凡18～60岁40例。氰化法测定血红蛋白（Hb），荧九光改计法测定红细胞原DI【，咐（FEP），、双毗院法测定叽i．’j铁（SI），MP－1型溶出分析仪测定血铅（BPb）、血清钢（C。）、锌（m）。结盟见人1，2。讨论1、IDA与BPb的关系人体Ph含量增高时可发生毒性反应，重者导致贫血，尤其影响儿童体格和心理发育’‘’，但BPb术达中毒水平前对IDA有何影响…     

川崎病患儿外周血中红细胞和血小板参数的变化

川崎病（KD）是一种以全身血管炎为主要病理改变的急性发热、出诊性疾病：多数患儿还可以出现贫血、血小板数升高等改变。本文通过全自动血细胞计数仪对KD患儿的外周血红细胞和血小板参数的观察，发现其贫血患儿的平均红细胞体积（MCV）降低、红细胞分布宽度（RDW）增高，为小细胞不均一性贫血，符合缺铁性贫血的表现。KD患儿血小板数普遍较高，尤其病程早期的平均血小板体积（MPV）增高，提示有血小板增多的趋势和在血管炎性反应中的重要作用。因此，对KD患儿应尽早使用抗血小板药物，在治疗过程中注意对缺铁性贫血的纠正。     

铅污染区儿童血铅与锌原卟啉、红细胞参数相关性研究

目的 探讨铅污染区儿童血铅与锌原卟啉、红细胞参数相关性。方法 对云南某县铅锌矿区和县城非铅锌矿区2～9岁儿童共464人进行血铅（BPb）水平、红细胞参数及锌原卟啉（ZPP）水平调查，按血铅水平分为高、低血铅组并进行血Pb与红细胞参数（RBC、HB、HCT、MCV、MCH、MCHC、RDW）及ZPP相关性分析。结果儿童血铅浓度均值154．4ug／L，铅中毒率79．1％，ZPP均值2．7ug／gHb。血铅〉250ug／L时，血铅与红细胞参数具有相关性（RR：0．637）。高铅组血铅水平与RBC、ZPP有较强相关性（r分别为：-0．975、0．957）。RBC随血铅水平增高呈高度负相关，血铅水平〈200ug／L时，与zPP无相关性。血铅水平达～250ug／L、～300u∥L、～350ug／L时，血铅与ZPP具有较强相关性（r分别为：0．567、0．93、0．886）并呈高度正相关。结论随血铅水平的增高，RBC与血铅呈高度负相关，当血铅水平〉250ug／L时，血铅与ZPP具有高度正相关性，而当血铅水平〈200ug／L时，与ZPP相关关系不密切，因此ZPP不能作为铅中毒筛查指标。     

小儿感染性疾病红细胞内锌原卟淋测定及其临床意义

为了解小儿感染性疾病红细胞内锌原卟淋（ZPP）值及其临床。方法：对61例小儿感染性疾病进行ZPP及血红蛋白（Hb)，红细胞计数（RBC）及平均红细胞体积（MCV）的测定，以健康体检儿童作为对照，结果： 感染组儿童ZPP值明显高于对照组（P＜0．05），Hb、MCV值明显低于对照组（P＜0．05），RBC值无明显差异（P＜0．05）。不同性别之间ZPP、Hb、RBC、MCV值无统计学差异（P＜0．05）。肺炎、肺结核、肠炎的ZPP值较上呼吸道感染及皮肤感染患儿高，败血症患儿ZPP值最高，Hb、RBC、MCV值较低，但无统计学差异（P＜0．05）。结论：小儿感染性疾病存在铁代谢紊乱。应用ZPP筛查铁缺乏症时，应避免感染因素的干扰，ZPP也可作为儿童感染及感染严重程度的观察指标。     

血细胞减少患儿血液标本中人微小病毒B19-DNA的检测

人微小病毒B19（HPVB19）可引起再生障碍性贫血，有时也可引起粒细胞减少、血小板减少及纯红细胞再生障碍性贫血。在接受化疗的患儿严重贫血时，也发现有HPVB19病毒血症。我们用PCR技术对1993年11月－1995年2月间20例血细胞减少和30例过敏性紫癜患儿的血清标本作了HPVB19－DNA检测，其中血小板减少9例，白血病4例，自身免疫性溶血性贫血2例，再生障碍性贫血2例，纯红细胞再生障碍性贫血2例，粒细胞缺乏1例。结果有2例阳性，1例为再生障碍性贫血，1例为急性粒细胞白血病M3型。阳性率为10％。30例过敏性紫癜均为阴性。     

缺铁性贫血对婴幼儿体格生长及智能行为发育的影响

目的：探讨缺铁性贫血（IDA）对婴幼儿体格生长智能行为发育的影响。方法：对264例婴幼儿的生长发育进行纵向监测，定期地体重，身高（长）、智力发育指数（MDI）、精神运动发能指数（PDI）以及行为问题进行测试，智能测试采用Bayley婴幼儿发育量表，行为测试采用Achenbach儿童行为筛查量表，根据2岁时有无IDA分为两组：1．贫血组（96例）；2．非贫血组（168例）建立数据库，用SPSS软件进行统计学分析。结果：贫血组2岁体重较对照组低（P＜0．05），1－2岁体重年增长率对照组低（P＜0．05）。2岁贫血线MDI、PDI均低于对照组，且这种改变在2．5岁贫血完全纠正时仍存在；另外2岁IDA患儿血红蛋白水平与其MDI和PDI分值呈正相关，行为方面贫血组2－3岁行为问题发生率明显高于对照组，突出表现在社交退缩和躯体诱述两个行为因子上。结论：IDA对婴幼儿体格生长和智能行为发育均产生不良影响，积极防治IDA对保证婴幼儿正常生长发育具有重要意义。     

血锌原卟啉和血清转铁蛋白受体测定对合并感染的缺铁性贫血患儿的诊断价值

目的　研究血锌原卟啉 (ZPP)和血清转铁蛋白受体 (sTfR)测定在合并感染的缺铁性贫血患儿中的诊断价值。方法　 1999～ 2 0 0 2年华中科技大学同济医学院附属同济医院采用血液荧光测定仪测定ZPP ,酶联免疫吸附试验法测定血清转铁蛋白受体 ,检测了 6 0例合并常见感染性疾病的缺铁性贫血 (IDA)患儿 ,设为感染合并IDA组 ,Hb( 70 4± 2 1 7)g/L。同时检测了 2 0例患同类感染性疾病的血红蛋白正常患儿 ,设为对照组 ,Hb( 12 3 1± 10 2 ) g/L。结果　ZPP :对照组为 ( 0 5 4± 0 18) μmol/L ,而感染合并IDA组为 ( 2 5 5± 1 72 ) μmol/L ,明显高于对照组 ( t=8 71,P <0 0 0 1)。血清转铁蛋白受体 :对照组为 ( 7 0 9± 2 32 )mg/L ,感染合并IDA组为 ( 2 4 4 0± 17 84 )mg/L ,亦显著高于对照组 (t =7 33,P <0 0 0 1)。结论　两种诊断IDA的新指标ZPP和sTfR受感染因素的影响较小 ,在合并常见感染性疾病的IDA患儿中 ,仍可作为诊断铁缺乏的良好指标     

红细胞体积分布宽度和平均红细胞体积诊断小儿潜在性缺铁临床价值探讨

目的　研究潜在性缺铁的诊断方法 ,以便早诊断、早防治。方法　对 4 11例 6个月至 6岁小儿进行血红蛋白 (Hb)、红细胞体积分布宽度 (RDW )、平均红细胞体积 (MCV)、血清铁蛋白 (SF)及红细胞游离原卟啉(FEP)检测 ,分析RDW、MCV与SF、FEP之间有无相关性。结果　RDW与SF呈负相关 ,与FEP呈正相关 ;MCV与SF呈正相关 ,与FEP呈负相关。结论　在铁缺乏症的高发群体中 ,基层医院用RDW与MCV代替SF与FEP作为粗略判断潜在性缺铁的检测指标具有一定的临床应用与推广价值。     

Red cell distribution width (RDW) in the diagnosis of iron deficiency with microcytic hypochromic anemia

Objective  To study the utility of red cell distribution width (RDW) in the diagnosis of iron deficiency among children with microcytic hypochromic anemia. Methods  151 children (6 months-12 years) with microcytic (MCV<75 fl) anemia were classified into iron deficient (IDA) and non-iron deficient anemia (non-IDA) on the basis of serum ferritin and total iron binding capacity (TIBC). RDW values were obtained on an automated hematology analyzer. Receiver operator curves (ROC) were constructed and the utility of RDW in diagnosis of iron deficiency was studied. Results  The mean RDW value was 18.37±2.22% in IDA group (97 children) compared to 16.55±1.51 % in the non-IDA group (54 children) (p<0.0001, unpaired t test). In IDA group, the mean RDW value was 16.60±1.78%, 17.95±1.91% and 20.55±1.32% among mild, moderate and severely anemic children (p<0.0001, ANOVA test). The corresponding values in non-IDA group were 16.03±1.25%, 16.76±1.20% and 16.77±2.68% respectively (p=0.269, ANOVA test). At a cut-off value of 17.4%, as obtained from the ROC curve, the sensitivity and specificity of RDW in diagnosis of IDA were 81.0% and 53.4% and a positive and negative predictive value of 63.0% and 72.2% respectively. Conclusion  RDW has a limited specificity for diagnosis of IDA among children with microcytic hypochromic anemia.     

Red Blood Cell Distribution Width and the Platelet Count in Iron-deficient Children Aged 0.5–3 Years

Early detection of iron deficiency (ID) and iron deficiency anemia (IDA) in young children is important to prevent impaired neurodevelopment. Unfortunately, many biomarkers of ID are influenced by infection, thus limiting their usefulness. The aim of this study was to investigate the value of red blood cell distribution width (RDW) and the platelet count for detecting ID(A) among otherwise healthy children. A multicenter prospective observational study was conducted in the Netherlands to investigate the prevalence of ID(A) in 400 healthy children aged 0.5–3 years. ID was defined as serum ferritin (SF) <12 μg/L in the absence of infection (C-reactive protein [CRP] <5 mg/L) and IDA as hemoglobin <110 g/L combined with ID. RDW (%) and the platelet count were determined in the complete blood cell count. RDW was inversely correlated with SF and not associated with CRP. Calculated cutoff values for RDW to detect ID and IDA gave a relatively low sensitivity (53.1% and 57.1%, respectively) and specificity (64.7% and 69.9%, respectively). Anemic children with a RDW >14.3% had a 2.7 higher odds (95% confidence interval [CI]: 1.2–6.3) to be iron deficient, compared with anemic children with a RDW <14.3%. The platelet count showed a large range in both ID and non-ID children. In conclusion, RDW can be helpful for identifying ID as the cause of anemia in 0.5- to 3-year-old children, but not as primary biomarker of ID(A). RDW values are not influenced by the presence of infection. There appears to be no role for the platelet count in diagnosing ID(A) in this group of children.     

小儿感染性疾病红细胞内锌原卟淋测定及其临床意义

为了解小儿感染性疾病红细胞内锌原卟啉 (ZPP)值及其临床意义。方法 :对 6 1例小儿感染性疾病进行ZPP及血红蛋白 (Hb)、红细胞计数 (RBC)及平均红细胞体积 (MCV)的测定 ,以健康体检儿童作为对照。结果 :感染组儿童ZPP值明显高于对照组 (P <0 0 5 ) ,Hb、MCV值明显低于对照组 (P <0 0 5 ) ,RBC值无明显差异 (P<0 0 5 )。不同性别之间ZPP、Hb、RBC、MCV值无统计学差异 (P <0 0 5 )。肺炎、肺结核、肠炎的ZPP值较上呼吸道感染及皮肤感染患儿高 ,败血症患儿ZPP值最高 ,Hb、RBC、MCV值较低 ,但无统计学差异 (P <0 0 5 )。结论 :小儿感染性疾病存在铁代谢紊乱。应用ZPP筛查铁缺乏症时 ,应避免感染因素的干扰 ,ZPP也可作为儿童感染及感染严重程度的观察指标。     

缺铁性贫血患儿血清胃泌素水平测定及间断补铁疗效观察

研究缺铁性贫血 (IDA)儿童胃泌素水平的变化 ;观察间断补铁治疗儿童IDA的疗效。方法 :49例 IDA患儿每周口服一次铁制剂 (元素铁 2 mg/kg) ,共 1 2周。在治疗前后测查 Hb、ZPP、SF及血清胃泌素。结果 :经补铁治疗 ,Hb、SF均极显著性升高 (P<0 .0 1 ) ,ZPP则明显下降 (P<0 .0 1 ) ;IDA患儿血清胃泌素水平明显升高 ,与对照组比较差异显著 ,治疗后恢复正常。结论 :1每周一次间断补铁治疗儿童 IDA效果显著。 2 IDA患儿胃泌素的异常分泌可能与缺铁所致的胃粘膜萎缩有关     

Learning achievement and behavior at school of anemic and non-anemic infants

In a prospective study the learning achievement and behaviour of second grade children who were anemic in infancy (n = 20) was compared with that of non-anemic children (n = 55). All children received preventive care and were under surveillance from birth at the Community Health and Research Center of Hadassah in Jerusalem. The anemic children had a hemoglobin level of less than 10.5 g/dl whereas the comparison group had more than 11.5 g/dl at 9 months of age. The learning achievement score was significantly lower in the anemic group 9.3 S.D. 3.8, than in the non-anemic group 11.5 S.D. 2.9 (P = 0.009). The positive task orientation was also significantly lower in the anemic group, though on additional behavior scores no differences were found. Differences remained significant even after controlling for maternal education and sex of child in a multivariate analysis. It is possible that an iron deficiency state which persists during the critical period of brain development in infancy has long-lasting effects on cognitive functioning. Prevention of iron deficiency may contribute to promotion of child development and better achievement.     

Non-anaemic iron deficiency identified by ZPP test in extremely premature infants: prevalence,dietary risk factors,and association with neurodevelopmental problems

Introduction: The aims of this study were to determine, in a cohort of extremely premature infants, the prevalence of iron deficiency identified by zinc protoporphyrin/heme ratio (ZPP) testing, and its association with neurodevelopmental problems and dietary risk factors for iron deficiency. Methods: Infants of less than 29 weeks' gestation or less than 1000 g birth weight were studied prospectively at a multidisciplinary follow-up clinic. Assessments were made at a corrected age of either 12 months (n=72) or 2 years (n=69). Physical examination, Griffiths Developmental Scale, and neurosensory-motor assessment were administered, information on diet and behaviour was obtained by questionnaire, and a fingerprick ZPP ratio was performed to identify iron deficiency. Results: 18.4% of infants had positive ZPP tests. There was no significant association between a positive ZPP test result and dietary risk factors, or symptoms of lethargy, irritability or poor attention. In children without cerebral palsy, there was no difference on Griffiths scores or neurosensory-motor assessment between ZPP-positive and ZPP-negative groups. The diagnosis of cerebral palsy (n=12) was significantly associated with both a positive ZPP test and a lower Griffiths general quotient (GQ) score. Conclusions: Iron deficiency occurs commonly in extremely low birth weight (ELBW) children in early childhood, and is not predicted by dietary risk factors. The prevalence of iron deficiency is increased in ELBW children with cerebral palsy. Non-anaemic iron deficiency (NAID) does not impair development or significantly affect behaviour of ELBW subjects who do not have cerebral palsy.     

Neutrophil hypersegmentation and thrombocytosis in children with iron deficiency anemia

Neutrophil hypersegmentation is an expected peripheral blood smear finding in megaloblastic anemias. But some clinical reports suggest that neutrophil hypersegmentation may also occur in patients with iron deficiency anemia. In this study we searched the presence of neutrophil hypersegmentation and thrombocytosis in patients with iron deficiency anemia but who had normal serum vitamin B12 and folic acid levels. The study comprised 102 patients with iron deficiency anemia and 21 age-matched healthy controls. All routine tests for iron deficiency anemia were done, serum folate and cobalamin levels were measured, and platelets were counted in all patients and controls. Peripheral blood smears were examined for neutrophil hypersegmentation. Hypersegmentation was found in 30.4% of anemic patients and in 9.5% of controls (p < 0.05). The number of platelets was also significantly higher in anemic children (p < 0.05). These results show that neutrophil hypersegmentation may also be seen in patients with iron deficiency anemia, and thrombocytosis is a common laboratory finding in this disorder.     

Red blood cell distribution width is not a reliable biomarker for low iron stores in children with cystic fibrosis

Low iron stores in children, absolute iron deficiency (AID), can lead to impaired neurodevelopment and requires iron therapy. In the presence of infection/inflammation, like in cystic fibrosis (CF), serum ferritin (SF) is not a reliable biomarker for AID. Red blood cell distribution width (RDW) is a promising alternative reported not to be influenced by infection in healthy children. Currently, there are no data on the diagnostic capacity of RDW to detect AID in pediatric CF patients. This was a prospective observational study that investigated iron status biomarkers in 53 Dutch pediatric CF patients. AID was defined using World Health Organization criteria for SF in stable patients (no recent pulmonary exacerbation) and C-reactive protein (CRP) ≤10 mg/l. Patients with AID had higher RDW levels than patients without AID (p = 0.019). An RDW ≥13.2% showed the following test statistics: sensitivity 100%; specificity 39.4%; positive predictive value 20%; and negative predictive value 100%. Furthermore, we found a correlation between RDW and CRP in the total group that originated from the stable patients (r = 0.308; p = 0.042). In conclusion, the diagnostic capacity of RDW for detecting AID in pediatric CF patients seems limited because RDW levels might also be influenced by chronic infection/inflammation in these patients.     

Iron deficiency in an Eskimo village. The value of serum ferritin in assessing iron nutrition before and after a three-month period of iron supplementation.

The serum ferritin concentration, a new means of assessing iron nutrition, was utilized in conjunction with the hematocrit value, serum iron concentration, and total iron binding capacity to determine the effect of a three-month period of iron supplementation in a group of 146 Eskimo children in Chevak, Alaska. Before treatment, 41% of the children had concentrations of serum ferritin below normal, 18% had a subnormal serum transferrin saturation, and 26% were anemic. After supplementation, only 6% had a subnormal serum ferritin concentration. Despite this evidence of improved iron stores in the group as a whole, the prevalence of low serum transferrin saturation and of anemia remained high, 15% and 17%, respectively. These results could be explained by a high incidence of infection, which, like iron deficiency, is associated with anemia and a low serum transferrin saturation. We conclude that the serum ferritin determination reflected an improvement in iron nutrition that was not as readily apparent by other measurements, and that factors other than iron deficiency also played an important role in the mild anemia that was prevalent in Chevak.