10.5826/dpc.1203a151
Objective: Telogen effluvium is one of the chronic diseases that affect the quality of life (QoL) in women. The study aimed to evaluate the RDW/MCV ratio and its correlation with ferritin in Telogen Effluvium patients and to reveal their potential role in the etiopathogenesis of Telogen effluvium.
Material and Methods: We retrospectively evaluated the medical data of 250 patients who were admitted to the dermatology outpatient clinic between September 2020 and December 2020 with a diagnosis of Telogen effluvium. The control group was created retrospectively from the medical records of 250 healthy individuals. HB, HCT, MPV, MCV, RDW, ferritin, and MCV/RDW ratio of both groups were compared and evaluated statistically.
Results: All of the Telogen effluvium patients were women in terms of gender. The mean age of the patient group was 33,11±9,66 years and the mean age of the control group was 34,98±12,37 years. The ratio of MCV/RDW, MPV, MCV, and ferritin is lower in the group with Telogen effluvium compared to the control group and a statistically significant difference was found(p&lt;0.05). However, the correlation between MCV/RDW ratio and ferritin was evaluated in Telogen effluvium patients, and no significant differences were found (p&gt;0.05).
Conclusion: Iron deficiency anemia is thought of as a factor in female patients with telogen effluvium. Although the data shows the correction of iron deficiency is insufficient telogen effluvium, we proposed that laboratory tests should be routinely used in the diagnosis and treatment phase of patients who apply with the complaint of hair loss.
text/xml
2160-9381
2217
en
Turan Akdağ
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
alopecia
Evaluation of MCV/RDW Ratio and Correlations with Ferritin in Telogen Effluvium Patients: Evaluation of MCV/RDW Ratio in Telogen Effluvium
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2022-07-28
2021-12-03
2022-07-28
2022-09-13
e2022151
Dermatol Pract Concept
Objective: Telogen effluvium is one of the chronic diseases that affect the quality of life (QoL) in women. The study aimed to evaluate the RDW/MCV ratio and its correlation with ferritin in Telogen Effluvium patients and to reveal their potential role in the etiopathogenesis of Telogen effluvium.
Material and Methods: We retrospectively evaluated the medical data of 250 patients who were admitted to the dermatology outpatient clinic between September 2020 and December 2020 with a diagnosis of Telogen effluvium. The control group was created retrospectively from the medical records of 250 healthy individuals. HB, HCT, MPV, MCV, RDW, ferritin, and MCV/RDW ratio of both groups were compared and evaluated statistically.
Results: All of the Telogen effluvium patients were women in terms of gender. The mean age of the patient group was 33,11±9,66 years and the mean age of the control group was 34,98±12,37 years. The ratio of MCV/RDW, MPV, MCV, and ferritin is lower in the group with Telogen effluvium compared to the control group and a statistically significant difference was found(p&lt;0.05). However, the correlation between MCV/RDW ratio and ferritin was evaluated in Telogen effluvium patients, and no significant differences were found (p&gt;0.05).
Conclusion: Iron deficiency anemia is thought of as a factor in female patients with telogen effluvium. Although the data shows the correction of iron deficiency is insufficient telogen effluvium, we proposed that laboratory tests should be routinely used in the diagnosis and treatment phase of patients who apply with the complaint of hair loss.
Turan Akdağ
2022/07/28
10.5826/dpc.1203a151
e2022151
Necmettin Erbakan University, Meram Vocational School, Konya, Turkey
2160-9381
alopecia
en
e2022151
Fava C, Cattazzo F, Hu ZD, Lippi G, Montagnana M. The role of red blood cell distribution width (RDW) in cardiovascular risk assessment: useful or hype? Ann Transl Med. 2019;7(20):581.
Evaluation of MCV/RDW Ratio and Correlations with Ferritin in Telogen Effluvium Patients: Evaluation of MCV/RDW Ratio in Telogen Effluvium
https://dpcj.org/index.php/dpc/article/download/2217/1687
                   Dermatology Practical & Conceptual


      Evaluation of MCV/RDW Ratio and Correlations
        With Ferritin in Telogen Effluvium Patients
                                Saadet İbiş1, Gülhan Aksoy Saraç2, Turan Akdağ3


1 Karapınar State Hospital Biochemistry Laboratory Karapınar, Konya, Turkey
2 Ufuk University Faculty of Medicine, Department of Dermatology, Ankara, Turkey
3 Necmettin Erbakan University, Meram Vocational School, Konya, Turkey



Key words: Telogen effluvium, MCV/RDW, ferritin, correlation, alopecia
Citation: İbiş A, Aksoy Saraç G, Akdağ T. Evaluation of MCV/RDW ratio and correlations with ferritin in telogen effluvium patients.
Dermatol Pract Concept. 2022;12(3):e2022151. DOI: https://doi.org/10.5826/dpc.1203a151
Accepted: December 22, 2021; Published: July 2022
Copyright: ©2022 İbiş et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: Concept – GAS, TA, SK, Design - GAS, TA, Supervision – GAS, TA, SK, Funding - None; Materials – GAS, SK Data collection
and/or processing – GAS, SK; Analysis and/or interpretation – GAS, TA, SK, Literature search – GAS, TA, SK: Writing – GAS, TA, Critical
review – GAS, TA, SK.
Corresponding author: Gülhan Aksoy Saraç, Ufuk University Faculty of Medicine, Department of Dermatology, Ankara/Turkey, E-mail:
gulhan1984@yahoo.com




  ABSTRACT             Introduction: Telogen effluvium is one of the chronic diseases that affect the quality of life (QoL) in
                       women. Genetic factors, vitamin deficiencies, hormonal and environmental conditions take roles in
                       the etiology of hair loss.
                       Objectives: The study aimed to evaluate the RDW(Red cell distribution witdh)/MCV(Mean corpus-
                       cular volume) ratio and its correlation with ferritin in Telogen Effluvium patients and to reveal their
                       potential role in the etiopathogenesis of Telogen effluvium.
                       Methods: We retrospectively evaluated the medical data of 250 patients who were admitted to the
                       dermatology outpatient clinic between September 2020 and December 2020 with a diagnosis of telo-
                       gen effluvium. The control group was created retrospectively from the medical records of 250 healthy
                       individuals. HB(Hemoglobin), HCT(Hematocrit), MPV(mean platelet volume), MCV, RDW, ferritin,
                       and MCV/RDW ratio of both groups were compared and evaluated statistically.
                       Results: All telogen effluvium patients were women in terms of gender. The mean age of the patient
                       group was 33.11 ± 9.66 years and the mean age of the control group was 34.98 ± 12.37 years. The
                       ratio of MCV/RDW, MPV, MCV, and ferritin is lower in the group with telogen effluvium compared
                       to the control group and a statistically significant difference was found (P < 0.05).
                       Conclusions: Iron deficiency anemia is thought of as a factor in female patients with telogen effluvi-
                       um. Although the data shows the correction of iron deficiency is insufficient telogen effluvium, we pro-
                       posed that laboratory tests should be routinely used in the diagnosis and treatment phase of patients
                       who apply with the complaint of hair loss.




Original Article | Dermatol Pract Concept. 2022;12(3):e2022151                                                                        1
Introduction                                                         individuals who applied to family health centers, with no
                                                                     complaints of hair loss or any other inflammatory skin dis-
The etiology of hair loss consists of unavoidable genetic fac-       ease, and were similar to the patient group in terms of mean
tors as well as hormonal reasons, vitamin deficiencies, and          age and gender. Patients who were in the period of chronic
environmental reasons. Hair loss is seen as an important cos-        disease, stress, thyroid disease, pregnancy, lactation, had a
metic problem that is increasing day by day, and therefore, the      history of surgical operation in the last 3 months, and took
number of patients who apply to clinics is increasing [1,2].         vitamin supplements were excluded from the study.
    Studies have shown that the most common cause of hair               Serum ferritin levels were evaluated by electrochemilu-
loss in women is telogen effluvium, and it’s listed that the most    minescence (ECLIA, Roche) method, and hemogram param-
common factors causing hair loss as low ferritin, vitamin B12        eters (HGB, HCT, MPV, and RDW) were performed with
deficiency, and thyroid dysfunctions [3,4]. Iron deficiency          Mindray BC-6800 (Mindray Bio-Medical Electronics Co.,
is the most common nutritional deficiency in the world [5].          Ltd) hematology analyzer which analyzes complete blood
One of the many problems caused by iron deficiency is hair           count based on laser light scattering (forward and light
loss [3]. It can even be considered as one of the most accused       scatter) and side fluorescent light. This retrospective study
factors in the etiology of this disease [6,7]. It is thought that    was approved by the Non-Invasive Clinical Research Ethics
hair loss develops due to the lack of iron, which plays a role       Committee of Necmettin Erbakan University (Decision No:
in oxygen transport to the tissues, and the inability to carry       2021/3515). The study has conducted by the principles of
enough oxygen to the hair follicle [8]. Iron is stored by ferritin   the Declaration of Helsinki.
together with apoferritin, and serum ferritin level reflects iron
stores in the body [9]. Kantor et al found low serum iron levels     Statistical Analysis
in patients with diffuse hair loss in their study, while Rushton     SPSS version 25.0 program was used for database creation
et al found low ferritin levels in 72% of the patients [10,11].      and statistical analysis. Pearson correlation test was used to
Özden et al reported that women with diffuse hair loss had a         measure the relationship and degree of relationship between
low ferritin value of 36%, and in another study when 72 mg           variables and P < 0.05 was accepted as significance limit.
of iron was given daily to 22 women with chronic hair loss,
they have shown that hair loss decreased [5,12].
    The red cell distribution range (RDW) is a measure of            Results
the heterogeneity of circulating erythrocytes. High RDW can
                                                                     All patients consisted of females in the study. The mean age
generally occur as a result of increased erythrocyte destruc-
                                                                     of the patient group was 33.11 ± 9.66 years and the mean
tion (hemolysis), nutritional deficiency, or blood transfusion
                                                                     age of the control group was 34.98 ± 12.37 years. There
[13]. In addition, RDW elevation is observed as a result of
                                                                     was no difference between the two groups in terms of age
ineffective erythropoiesis due to chronic inflammation and
                                                                     (P > 0.05).
neurohumoral activation [14].
                                                                        RDW value was elevated in telogen effluvium patients
                                                                     (P = 0.02), MPV and MCV values were decreased in telo-
Objectives                                                           gen effluvium patients compared with the control group as
                                                                     P = 0.00 and P = 0.04, respectively. MCV/RDW ratio of the
As far as we know, the role of iron, RDW, and MCV(Mean               telogen effluvium patients was lower than the MCV/RDW
corpuscular volume) in hair loss seems unresolved so far.            ratio of the control group as 6.41 versus 7.41 (P = 0.00)
Since the laboratory reference intervals were different in the       (Table 1). The correlation between MCV/RDW ratio and fer-
studies, the results were also controversial. The spresent tudy      ritin was evaluated, and no significant correlation was found
aimed to evaluate the RDW/MCV ratio and its correlation              between the parameters (P > 0.05). When patients with tel-
with ferritin in patients with telogen effluvium and to reveal       ogen effluvium with positive and negative pull tests were
the roles of telogen effluvium in its etiopathogenesis.              compared, no statistically significant difference was found
                                                                     between the two groups in terms of HB, HCT, MPV, MCV,
Methods                                                              RDW, ferritin, and MCV/RDW ratios (P > 0.05) (Table 2).

We retrospectively evaluated the medical data of 250 pa-
                                                                     Conclusions
tients who were admitted to the dermatology outpatient
clinic between September 2020 and December 2020 with                    Telogen effluvium is the most common cause of diffuse
a diagnosis of telogen effluvium. The diagnosis of telogen           hair loss. Also, it’s a non-cicatricial form of hair loss that de-
effluvium was performed as clinical. The control group was           velops approximately 3 months after a triggering factor and
created retrospectively from medical records of 250 healthy          is characterized by widespread hair loss. Telogen effluvium


2                                                                        Original Article | Dermatol Pract Concept. 2022;12(3):e2022151
                  Table 1. Comparison of some parameters between patient and control group
                                           Patient group                Control group                           P
 Age, years, mean ± SD                       33.11±9.66                    34.98±12.37                       > 0.05
 HB, g/dL                                       13.60                         13.47                          > 0.05
 HCT, %                                         42.13                         40.18                          > 0.05
 MPV, µm3                                        7.83                         10.47                            0.00
 MCV, fL                                        84.22                         86.65                            0.04
 RDW, %                                         14.30                         11.68                            0.02
 Ferritin, µg/L                                 28.83                         64.89                            0.00
 MCV/RDW, fL/%                                   6.41                         7.41                             0.00
HB = hemoglobin; HCT = hematocrit; MPV = mean platelet volume; MCV = mean corpuscular volume; MCV/RDW m= mean corpuscular
volume/red cell distribution width ratio; RDW = red cell distribution width; SD = standard deviation.



                  Table 2. Comparison of telogen effluvium with positive and negative pull test
                            Pull test                                  N                    Mean                      P
                                                 Positive              66                   13.50
 HB                                                                                                                 >0.05
                                                 Negative             146                   13.64
                                                 Positive              66                   40.30
 HCT                                                                                                                >0.05
                                                 Negative             146                   42.95
                                                 Positive              66                    7.78
 MPV                                                                                                                >0.05
                                                 Negative             146                    7.85
                                                 Positive              66                   85.47
 MCV                                                                                                                >0.05
                                                 Negative             146                   85.10
                                                 Positive              66                   11.72
 RDW                                                                                                                >0.05
                                                 Negative             146                   11.66
                                                 Positive              66                   30.71
 Ferritin                                                                                                           >0.05
                                                 Negative             146                   27.97
                                                 Positive              66                    7.43
 MCV/RDW                                                                                                            >0.05
                                                 Negative             146                    7.41
HB = hemoglobin; HCT = hematocrit; MPV = mean platelet volume; MCV = mean corpuscular volume; MCV/RDW m= mean corpuscular
volume/red cell distribution width ratio; RDW = red cell distribution width.



can be observed in both genders. On the other hand, women         ferritin levels and hair loss [20]. A recent study reported that
constitute the majority of patients who apply for treat-          telogen effluvium patients had significantly lower serum fer-
ment, because the frequency of the disease may be higher in       ritin concentrations compared to those in the control group
women, or that the number of admissions in men is low and         (17.35 ± 18.54 ng/ml versus 39.27 ± 29.44 ng/ml, P = 0.001)
the cases remain subclinical [15,16].                             [21]. As similar, patients with telogen effluvium had lower
    Several studies were reported that fever, stress, major       serum ferritin levels which compared to the control group in
surgery, increase in androgen or estrogen hormone levels,         our study (28.83 µg/L versus 64.89 µg/L, P = 0.00) (Table 1).
hyperthyroidism, and many other causes have been associ-             MCV, is known as one of the red blood cell indices and
ated with telogen effluvium [17]. To define the etiological       defines the size of the red blood cells. MCV could determine
diagnosis in telogen effluvium, a detailed history, and labora-   the classification of anemia as microcytic anemia below the
tory tests to exclude endocrine, nutritional, and autoimmune      normal range, normocytic anemia within the normal range,
diseases should be performed [18].                                macrocytic anemia above the normal range [22]. Ferritin is
    While many studies have reported serum iron deficiency        a measure of iron stores and the most sensitive biomarker
in telogen effluvium patients, some of them do not show a         to test for early stages of iron deficiency as well as iron de-
relationship between iron deficiency and the incidence of         ficiency anemia. Obaidat et al reported a significant associ-
telogen effluvium [19]. Sinclair et al declared that low se-      ation between low serum ferritin levels and chronic telogen
rum ferritin and hair loss were show not a relation between       effluvium [23].



Original Article | Dermatol Pract Concept. 2022;12(3):e2022151                                                                  3
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