Correlation Between Red Blood Cell Distribution Width and Acute Coronary Syndrome in Mosul City

Khalid N. M. Al-Khero; Waad Fadhil  Abdullah; Emad Abdul Jaber  Thanoon

doi:10.17605/cajmns.v6i3.2823

Khalid N. M. Al-Khero Department of Medicine, College of Medicine, University of Mosul, Mosul, Iraq
Waad Fadhil Abdullah Alsalam Hospital
Emad Abdul Jaber Thanoon Department of Pharmacology, College of Medicine, University of Mosul, Iraq

DOI: https://doi.org/10.17605/cajmns.v6i3.2823

Keywords: Red Blood Cell Distribution Width, Leukocytosis, NSTEMI, Troponin I Level, Ejection Fraction

Abstract

Red cell distribution width (RDW) is a quantitative assessment of anisocytosis, reflecting variability in the size of red blood cells. This measurement is typically included in the complete blood count reported by haematology laboratories. Emerging research indicates that RDW may offer significant prognostic insights regarding clinical outcomes in acute coronary syndrome. To evaluate the relationship between elevated red cell distribution width (RDW) in patients experiencing acute coronary syndrome (ACS) and findings from electrocardiography (ECG), troponin I levels, white blood cell count (WBC), and ejection fraction (EF). The study involved 100 patients admitted to the Intensive Cardiac Care Unit (ICCU) at Ibn-Sina Teaching Hospital in Mosul, Iraq, between October 2018 and March 2019. Of the participants, 77 were male and 23 were female. Demographic information was collected, and informed consent was obtained from the patients or their relatives. Patients with haemoglobinopathy, enzymopathy, membrane defects, leukaemia, pulmonary hypertension, chronic obstructive pulmonary disease, renal diseases, iron deficiency, and chronic inflammatory conditions were excluded from the study. All patients were tested for haemoglobin (Hb), packed cell volume (PCV), white blood cell (WBC) count, and red cell distribution width (RDW) using a haematological analyzer from Nihon Corporation. The troponin I assay was also conducted using the Monoclonal Antibody Technique and an Enzyme-Linked Immunofluorescent Assay. Echocardiography was also performed, all within 24 hours of admission. Results: The study identified 19 patients with elevated levels of Red Cell Distribution Width (RDW), comprising 16 males and 3 females. Among these patients, one was younger than 50 years old, 15 were between 50 and 60 years old, and 3 were over 60 years old. A significant correlation was observed between elevated RDW levels and an ejection fraction (EF) of less than 50% (p < 0.05). In contrast, RDW levels were normal in the remaining 81 patients. Of these, 43 had an EF greater than 50%, while 38 had an EF below 50%. Elevated levels of cardiac troponin I, high white blood cell (WBC) counts and the use of thrombolytic drugs were significantly associated with increased red cell distribution width (RDW) levels (p < 0.05). There was a notable relationship between elevated RDW, increased troponin I levels, leukocytosis, and decreased ejection fraction (EF) in patients diagnosed with non-ST elevation myocardial infarction (NSTEMI). Additionally, a significant association was found between increased RDW, elevated troponin I level, leukocytosis, and decreased EF in patients with non-ST elevation myocardial infarction (NSTEMI). In patients diagnosed with acute coronary syndrome (ACS), a significant association was found between increased red cell distribution width (RDW), elevated troponin I levels, leukocytosis, and reduced ejection fraction (EF) in cases of non-ST elevation myocardial infarction (NSTEMI). These factors may serve as predictors for the severity and outcomes of acute myocardial infarction (MI).

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