Eritrosit Dağılım Genişliği (RDW)’nin Kronik Venöz Yetmezlikte Tanı Aracı Olarak Kullanımı

Year 2020, Volume: 3 Issue: 2, 79 - 85, 31.08.2020

Özge Turgay Yıldırım Mustafa Emin Çanakçı Murat Bayav

Abstract

Giriş
Kronik venöz yetmezlik (KVY) kronik bir enflamatuar hastalıktır ve yayınlanan çalışmalarda bazı biyobelirteçlerin KVY hastaları için prediktif değeri olduğu gösterilmiştir. Eritrosit dağılım genişliği (RDW), dolaşımdaki eritrositlerin heterojenliğinin bir ölçüsüdür. Biz bu çalışma ile RDW ve KVY sınıflandırması arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntemler
Bu çalışmada alt ekstremite venöz Doppler ultrasonu çekilmiş 102 hasta değerlendirildi. Doppler ultrason sonuçları, hematolojik ve biyokimyasal laboratuvar sonuçları retrospektif olarak hastane tıbbi kayıtlarından elde edildi.
Çalışma popülasyonu Doppler ultrason sonuçlarına göre kronik venöz yetmezlik grubu ve kontrol grubuna ayrıldı. Kronik venöz yetmezlik grubu CEAP sınıflandırmasının klinik bulgularına göre sınıflandırıldı.
Bulgular
Toplam 102 hasta çalışmaya dahil edildi. Çalışma popülasyonunun ortalama yaşı 52.3±14.6 ve 54'ü (%52,9) erkekti. Hastaların% 25,5'i CVI grubuna,% 74,5'i kontrol grubuna alındı. Çalışma popülasyonunun CEAP sınıflandırmasının klinik bulgularına göre % 21,6'sı (n=26) Sınıf 1, %44,1'i (n=45) Sınıf 2 ve %8,8'i (n=9) Sınıf 3 olarak sınıflandırıldı. RDW, venöz yetmezlik grubunda kontrol grubuna göre anlamlı derecede yüksekti (p = 0.02). İkili karşılaştırmada; Sınıf 1 ile Sınıf 2 arasında p= 0,150; Sınıf 1 ile Sınıf 3 arasında p = 0,125 ve Sınıf 2 ile Sınıf 3 arasında p= 0,05 saptandı.
Sonuç:
Sonuçlarımız RDW'nin CVI için bir tanı aracı olarak kullanılabileceğini, ancak CVI'nın şiddetinin RDW tarafından belirlenemeyeceğini göstermektedir.

Keywords

Eritrosit Dağılım Genişliği, RDW, Kronik Venöz Yetmezlik, Kronik Venöz Yetmezlik Sınıflaması

Red Cell Distribution Width (RDW) as a Diagnostic Tool for Chronic Venous Insufficiency

Abstract

Introduction
Chronic venous insufficiency (CVI) is a chronic inflammatory disease and biomarkers are defined to be used as predictive biomarkers for CVI patients. Red cell distribution width (RDW) is a measure of heterogeneity of erythrocytes in circulation. With this study we aim to investigate the relationship between RDW and CVI classification
Materials and Methods
102 consecutive patients with lower extremity venous Doppler ultrasound were evaluated for the study. The Doppler ultrasound results, hematological and biochemical laboratory results were obtained retrospectively from hospital medical records.
The study population was divided to chronic venous insufficiency group and control group according to Doppler ultrasound results. Chronic venous insufficiency group also classified according to clinical findings of CEAP classification
Results
A total of 102 patients were included in the study. Mean age of the study population was 52.3 ± 14.6 and 54 (52.9%) was male. 25.5% of the patients were included in CVI group and 74.5% of the patients were included in the control group. 21.6% (n=26) of the study population was classified as Class 1, 44.1% (n=45) was classified as Class 2 and 8.8% (n=9) of the patients were classified as Class3 according to the clinical findings of the CEAP classification. RDW was significantly higher in venous insufficiency group compared to control group (p=0.02). The pairwise comparison of Class 1 to Class 2 was 0.150, Class 1 to Class 3 was p=0.125 and Class 2 to Class 3 was 0.05.
Conclusion
Our results propose that RDW may be used as a diagnostic tool for CVI but severity of CVI cannot be determined by RDW.

Keywords

Red cell distribution width, RDW, Chronic venous insufficiency, Chronic venous insufficiency classification

References

• 1. Nicolaides AN, Allegra C, Bergan J, et al. Management of chronic venous disorders of the lower limbs: Guidlines according to scientific evidence. International Angiology 2008;27:1–59
• 2. Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014 Jul 22;130(4):333-46.
• 3. Özgür Ö, Alimoğlu E, Çeken K, et al. Chronic venous insufficiency patterns in lower extremity veins detected by Doppler Ultrasound. Dicle Tıp Dergisi. 2013; 40(4): 548-543
• 4. Almeida JI, Wakefield T, Kabnick LS, Onyeachom UN, Lal BK. Use of the clinical, etiologic, anatomic, and pathophysiologic classification and venous clinical severity score to establish a treatment plan for chronic venous disorders. J Vasc Surg 2015; 3:456–460
• 5. Evans TC, Jehle D. The red blood cell distribution width. J Emerg Med 1991;9(1):71-4
• 6. Pierce CN, Larson DF. Inflammatory cytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device. Perfusion 2005;20(2):83-90.
• 7. Şen Tanrıkulu C, Karaman S, Demirelli S, et al. Akut Koroner Sendromlu Hastalarda Eritrosit Dağılım Aralığının (RDW) Değerlendirilmesi. Kocatepe Tıp Dergisi 2014;15(2):99-105.
• 8. Kato H, Ishida J, Imagawa S, et al. Enhanced erythropoiesis mediated by activation of the reninangiotensin system via angiotensin II type 1a receptor. FASEB J 2005;19(14):2023-5.
• 9. Biaggioni I, Robertson D, Krantz S, et al. The anemia of primary autonomic failure and its reversal with recombinant erythropoietin. Ann Intern Med 1994;121(3):181-6.
• 10. Fava C, Cattazzo F, Hu ZD, et al.The role of red blood cell distribution width (RDW) in cardiovascular risk assessment: useful or hype? Ann Transl Med. 2019 Oct;7(20):581.
• 11. Almeida JI, Wakefield T, Kabnick LS, et al. Use of the clinical, etiologic, anatomic, and pathophysiologic classification and venous clinical severity score to establish a treatment plan for chronic venous disorders. J Vasc Surg 2015; 3:456–460
• 12. Salvagno GL, Sanchis-Gomar F, Picanza A, et al. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015;52(2):86–105.
• 13. Patel KV, Ferrucci L, Ershler WB, et al. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009;169(5):515-23.
• 14. Perlstein TS, Weuve J, Pfeffer MA, et al. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009;169(6):588-94
• 15. Ramirez-Moreno JM, Gonzalez-Gomez M, Ollero-Ortiz A, et al. Relation between red blood cell distribution width and ischemic stroke: a case-control study. Int J Stroke 2013;8:E36.
• 16. Demirtas S, Karahan O, Yazici S, et al. The relationship between complete blood count parameters and Fontaine’s Stages in patients with peripheral arterial disease. Vascular 2014;22:427-31.
• 17. Borné Y, Smith JG, Melander O, et al. Red cell distribution width in relation to incidence of coronary events and case fatality rates: a population-based cohort study. Heart 2014;100:1119-24
• 18. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med 2005;352:1011–1023.
• 19. Franchini M, Zaffanello M, Veneri D. Advances in the pathogenesis, diagnosis and treatment of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Thromb Res 2006;118:177–184.
• 20. Reiter CD, Wang X, Tanus-Santos JE, Hogg N, Cannon RO III, Schechter AN, Gladwin MT. Cell-free hemoglobin limits nitric oxide bioavailability in sickle-cell disease. Nat Med 2002;8:1383–1389
• 21. Smith RK, Golledge J. A systematic review of circulating markers in primary chronic venous insufficiency. Phlebology 2014; 29:570–579.
• 22. Sayer GL, Smith PD. Immunocytochemical characterisation of the inflammatory cell infiltrate of varicose veins. Eur J Vasc Endovasc Surg 2004; 28:479–483.
• 23. Pocock ES, Alsaigh T, Mazor R, et al. Cellular and molecular basis of venous insufficiency. Vasc Cel 2014; 6:24
• 24. Karahan O, Yavuz C, Kankilic N, Simple blood tests as predictive markers of disease severity and clinical condition in patients with venous insufficiency. Blood Coagul Fibrinolysis. 2016 Sep;27(6):684-90