[Skip to Content]
[Skip to Content Landing]
February 26, 1992

Red Cell Distribution Width in Alcohol Abuse and Iron Deficiency Anemia-Reply

Author Affiliations

University of Texas Medical Branch at Galveston

JAMA. 1992;267(8):1071. doi:10.1001/jama.1992.03480080040014

In Reply.  —Dr Seppä and Mr Sillanaukee suggest that high RDW and normal MCV may herald early alcohol abuse. It is true that liver disease has been described as a common cause of isolated increased RDW.1,2 The challenge would now be to distinguish alcohol abuse per se from the liver disease that commonly results from alcohol abuse. Another point to note is that both early pernicious anemia and alcohol abuse-liver disease tend to be associated with high normal MCV, unlike early iron deficiency, which is associated with lownormal MCV.1 As in many other analyses with broad normal ranges, different parts of "normal" mean different things. We would concur that a high-normal MCV and high RDW suggest liver disease—alcohol abuse, early megaloblastic deficiency, and/or cytotoxic chemotherapy. As shown in our data, early iron deficiency with a normal MCV is predominantly found in the lower half (80 to 90 fL)