Assessment of Red Cell Distribution Width among Sudanese Patients with Subclinical Hypothyroidism

Khalid Abdelsamea Mohamedahmed, Mowahib Omar Mubarak, Albadawi Abdebagi Talha, Rania Saad Suliman, Amin Omer Ibrahim Abbas, Mosab Omer Khalid Mohammed Zeen, Abd Elgadir Alamin Altoum, Asaad Ma. Babker

 
International Journal of Biomedicine. 2023;13(2):229-233.
DOI: 10.21103/Article13(2)_OA4
Originally published June 5, 2023

Abstract: 

Background: Thyroid dysfunction has a strong association with anemia. Red blood cell distribution width (RDW) was traditionally regarded as a part of the routine evaluation of anemia. Several studies have indicated that elevated RDW level is significantly associated with subclinical hypothyroidism and hypothyroidism. The present study aimed to assess the impact of subclinical hypothyroidism (SHT) on RDW in Sudanese patients.
Methods and Results: The study was designed as a case-control, laboratory-based study carried out at the National Cancer Institute – University of Gezira (NCI-UG) (Wad Medani, Gezira State, Sudan) from January to October 2020.The samples were collected randomly from 100 subjects: 50 patients (mean age 38.50±10.46 years; 36% males and 64% females) with hypothyroidism (case group) and 50 apparently healthy individuals (mean age 35.52±11.64 years; 46% males and 54% females) (control group). The case group was divided into 2 subgroups: Sub1 included 43(86%) patients with SHT grade 1 (TSH of 6-10μIU/mL), and Sub2 included 7(14%) patients with SHT grade 2 (TSH>10μIU/mL). A 3ml venous blood sample was collected in an EDTA container from each participant. The parameters of the RBCs (RBC count, MCV, RDW-CV, and RDW-SD) were measured using the Sysmex XP-300 Automated Hematology Analyzer.
In the case group, the average levels of RDW-SD, RDW-CV, and MCV were higher than in the control group (P=0.000 in all cases). There was a significant difference in RDW-CV between Sub1 and Sub2 (P=0.040). We found no significant differences in RDW-SD and RDW-CV between different age groups. There was a significant difference in RBC count between different age groups (P=0.022), and significant differences in RBC count and MCV between males and females. RDW-SD and RDW-CV had a significant positive correlation within TSH and a significant negative correlation within T3 and T4.
Conclusion: RDW-CV may be used as a marker of SHT grade 2.

Keywords: 
red blood cell distribution width • hypothyroidism • Sudan
References: 
  1. Shetty A, Vijaya C. A study of hematological parameters and their correlation with thyroid hormone status in non-pregnant women of childbearing age. Indian J Pathol Oncol 2019;6(1):102-106. doi: 10.18231/2394-6792.2019.0018.
  2. Mohamedahmed KA, Ahmed AH, Talha AA, Babker AM. Alteration of Coagulation Profiles in Hypothyroid Patients. Int J Curr Res Physiol Pharmacol. 2022;6(2):1-5.
  3. Teng X, Shan Z, Chen Y, Lai Y, Yu J, Shan L, Bai X, Li Y, Li N, Li Z, Wang S, Xing Q, Xue H, Zhu L, Hou X, Fan C, Teng W. More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis: a cross-sectional study based on two Chinese communities with different iodine intake levels. Eur J Endocrinol. 2011 Jun;164(6):943-50. doi: 10.1530/EJE-10-1041.
  4. Chandel R, Chatterjee G, Abichandani L. Impact of subclinical hypothyroidism on iron status and haematological parameters. Ann Pathol Lab Med. 2015;2:21-25.
  5. Khan A, Khan MMA, Akhtar S. Thyroid Disorders, Etiology and Prevalence. J Med Sci. 2002;2(2):89-94. doi: 10.3923/jms.2002.89.94.
  6. Elnour A, Hambraeus L, Eltom M, Dramaix M, Bourdoux P. Endemic goiter with iodine sufficiency: a possible role for the consumption of pearl millet in the etiology of endemic goiter. Am J Clin Nutr. 2000 Jan;71(1):59-66. doi: 10.1093/ajcn/71.1.59.
  7. Elshaikh RH, Amir R, Ahmeide A, Mohamedahmed KA, Alfeel AH, Higazi H, Hussein SEO, Babker AMA. Evaluation of the Discrimination between Beta-Thalassemia Trait and Iron Deficiency Anemia Using Different Indexes. International Journal of Biomedicine. 2022;12(3):375-379. doi:10.21103/Article12(3)_OA4
  8. Zhou G, Ai Y, Guo S, Chen Q, Feng X, Xu K, Wang G, Ma C. Association Between Red Blood Cell Distribution Width and Thyroid Function. Front Endocrinol (Lausanne). 2022 Jan 18;12:807482. doi: 10.3389/fendo.2021.807482.
  9. Zhang Y, Xue Y, Cao C, Huang J, Hong Q, Hai T, Jia Q, Wang X, Qin G, Yao J, Wang X, Zheng Q, Zhang R, Li Y, Luo A, Zhang N, Shi G, Wang Y, Ying H, Liu Z, Wang H, Meng A, Zhou Q, Wei H, Liu F, Zhao J. Thyroid hormone regulates hematopoiesis via the TR-KLF9 axis. Blood. 2017 Nov 16;130(20):2161-2170. doi: 10.1182/blood-2017-05-783043. 
  10. Dorgalaleh A, Mahmoodi M, Varmaghani B, Kiani Node F, Saeeidi Kia O, Alizadeh Sh, Tabibian Sh, Bamedi T, Momeni M, Abbasian S, Kashani Khatib Z. Effect of thyroid dysfunctions on blood cell count and red blood cell indice. Iran J Ped Hematol Oncol. 2013;3(2):73-7. 
  11. Gu Y, Chi VTQ, Zhang Q, Liu L, Meng G, Wu H, Bao X, Zhang S, Sun S, Wang X, Zhou M, Jia Q, Song K, Niu K. Low-Normal Thyroid Function Predicts Incident Anemia in the General Population With Euthyroid Status. J Clin Endocrinol Metab. 2019 Nov 1;104(11):5693-5702. doi: 10.1210/jc.2019-00888. 
  12. Sibilla R, Santaguida MG, Virili C, Gargano L, Nardo S, Della Guardia M, Viceconti N, Franchi A, Centanni M. Chronic unexplained anaemia in isolated autoimmune thyroid disease or associated with autoimmune related disorders. Clin Endocrinol (Oxf). 2008 Apr;68(4):640-5. doi: 10.1111/j.1365-2265.2007.03091.x. 
  13. Szczepanek-Parulska E, Hernik A, Ruchała M. Anemia in thyroid diseases. Pol Arch Intern Med. 2017 May 31;127(5):352-360. doi: 10.20452/pamw.3985. 
  14. Shah N, Pahuja M, Pant S, Handa A, Agarwal V, Patel N, Dusaj R. Red cell distribution width and risk of cardiovascular mortality: Insights from National Health and Nutrition Examination Survey (NHANES)-III. Int J Cardiol. 2017 Apr 1;232:105-110. doi: 10.1016/j.ijcard.2017.01.045.
  15. Lahner E, Conti L, Cicone F, Capriello S, Cazzato M, Centanni M, Annibale B, Virili C. Thyro-entero-gastric autoimmunity: Pathophysiology and implications for patient management. Best Pract Res Clin Endocrinol Metab. 2020 Jan;34(1):101373. doi: 10.1016/j.beem.2019.101373. 
  16. Wang PF, Song SY, Guo H, Wang TJ, Liu N, Yan CX. Prognostic role of pretreatment red blood cell distribution width in patients with cancer: A meta-analysis of 49 studies. J Cancer. 2019 Jul 10;10(18):4305-4317. doi: 10.7150/jca.31598.
  17. Seyhan EC, Özgül MA, Tutar N, Ömür I, Uysal A, Altin S. Red blood cell distribution and survival in patients with chronic obstructive pulmonary disease. COPD. 2013 Aug;10(4):416-24. doi: 10.3109/15412555.2012.758697. 
  18. Yu HM, Park KS, Lee JM. The value of red blood cell distribution width in subclinical hypothyroidism. Arq Bras Endocrinol Metabol. 2014 Feb;58(1):30-6. doi: 10.1590/0004-2730000002836.
  19. Montagnana M, Lippi G, Targher G, Salvagno GL, Guidi GC. The red blood cell distribution width is associated with serum levels of thyroid stimulating hormone in the general population. Int J Lab Hematol. 2009 Oct;31(5):581-2. doi: 10.1111/j.1751-553X.2008.01082.x. 
  20. Aktas G, Sit M, Dikbas O, Tekce BK, Savli H, Tekce H, Alcelik A. Could red cell distribution width be a marker in Hashimoto's thyroiditis? Exp Clin Endocrinol Diabetes. 2014 Nov;122(10):572-4. doi: 10.1055/s-0034-1383564. 
  21. Geetha JP, Srikrishna R. Role of red blood cell distribution width (RDW) in thyroid dysfunction. Int J Biol Med Res. 2012;3(2):1476-1478.
  22. Iddah MA, Macharia BN, Ng'wena AG, Keter A, Ofulla AV. Thryroid hormones and hematological indices levels in thyroid disorders patients at moi teaching and referral hospital, Western kenya. ISRN Endocrinol. 2013 Apr 15;2013:385940. doi: 10.1155/2013/385940.
  23. Olt S, Selçuk MY, Tutak AS, Akbaş F, Öznas O. Investigation The Impact Of Hypothyroidism On Hematological Parameters. Mustafa Kemal Üniv Tıp Derg. 2016;7(25):23-27. doi: 10.17944/mkutfd.73132.
  24. Ahmed SS, Mohammed AA. Effects of thyroid dysfunction on hematological parameters: Case controlled study. Ann Med Surg (Lond). 2020 Jul 11;57:52-55. doi: 10.1016/j.amsu.2020.07.008. 
  25. Bilgin S, Tel BMA, Kahveci G, Duman TT, Kurtkulagi O, Yurum S, Erturk A, Balci B, Aktas G. Hypothyroidism is Strongly Correlated with Mean Platelet Volume and Red Cell Distribution Width. National Journal of Health Sciences. 2021;6:7-10. doi: 10.21089/njhs.61.0007
  26. Kadgi NV, Chauhan SG, Nakate LA. Hematological changes in hypothyroidism and hyperthyroidism in adults. Indian J Pathol Oncol. 2021;8(4):452-456. doi: 10.18231/j.ijpo.2021.094
  27. Tel BMA, Aktas G, Duman TT, Kurtkulagi O, Bilgin S, Kahveci G, Sagdic T. Association Between Thyroid Hormone Status and Complete Blood Count Parameters in Anemic Patients. Mal J Med Health Sci. 2021;17(1):101-104.
  28. Siddegowda MS, Chaithra R, Shivakumar S, et al. Effects of thyroid function on blood cell counts and red cell indices – a retrospective study at a tertiary care centre in Mandya, Karnataka. J Evid Based Med Healthc. 2021;8(27):2434-2438. doi: 10.18410/jebmh/2021/451
  29. Elbastawesy MA, Mahfouz KA, Rezk AA, Al Adl HA. pattern of blood cell parameters in thyroid dysfunction. AIMJ. 2022; 42-46. doi: 10.21608/aimj.2022.101495.1617
  30. Saba F, Sayyadipoor F. The Relationship Between Severity of Hypothyroidism and Red Blood Cells Indices. International Journal of Medical Laboratory. 2019;6(1):16-20. doi: 10.18502/ijml.v6i1.503
  31. Aparajita S, Manas T, Santasmita P. Red Blood Cell Indices and Hypothyroidism. JK Science. 2022;24(3):177-82

Download Article
Received February 1, 2023.
Accepted March 19, 2023.
©2023 International Medical Research and Development Corporation.