Red Cell Distribution Width in Alcohol Abuse and Iron Deficiency Anemia

To the Editor. —According to Bessman and McClure,1automated blood cell count, when it includes the red cell distribution width (RDW), is sufficient to detect iron deficiency in an ambulatory population. This seems to be true, especially with a mean corpuscular volume (MCV) of 99 fL or less. We have also found that a high RDW is frequently connected with alcohol abuse. The combination of a high MCV and a high RDW may indicate immune hemolytic anemia or a deficiency of folate or vitamin B12.2Our previously reported results3using a Coulter Counter S-Plus IV (Coulter Electronics Inc, Hialeah, Fla) showed that this combination may, however, also indicate alcohol abuse among male patients, even though the combination is seen more often with pernicious anemia. A combination of four Coulter parameters can distinguish nonanemic, macrocytic alcohol abusers from macrocytic patients with early, nonanemic pernicious anemia; 94%