Red cell distribution width is a predictor of mortality in patients with major bleeding

We have read with great enthusiasm the recently published article entitled ‘‘Impact of red blood cell distribution width on risk for bleeding events in patients with non-ST elevation acute coronary syndromes’’ by Gonçalves et al. In this wellpresented article they aimed to determine the prognostic value of red blood cell distribution width (RDW) in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS), particularly regarding the risk of major bleeding. They concluded that RDW was an independent predictor of major bleeding in patients with non-ST segment elevation myocardial infarction (NSTEMI). They suggested that higher RDW values were associated with greater in-hospital mortality and were an independent predictor of in-hospital major bleeding in patients with NSTE-ACS. The ready availability of this parameter at no additional cost may encourage its wider use in clinical practice in the future. We thank the authors for their contribution. It is known that anemia is an important predictor of shortand medium-term mortality after ACS. In the present study, there were significant differences between the third tertile of RDW compared to the other groups. Anemia can be an independent risk factor of ACS patients with major bleeding in the present study. RDW is a standard laboratory parameter that shows variation in red blood cell size on a standard hemogram and is usually used in assessing blood diseases. It has recently been reported as an independent predictor of all-cause long-term mortality in patients with coronary artery disease. However, conditions in the differential diagnosis of anemias can affect RDW and so this parameter might change in the presence of abnormalities such as thyroid disease, renal or hepatic dysfunction (creatinine >1.5 mg/dl or aspartate aminotransferase and alanine transaminase more than twice the upper limit of normal,