Red blood cell distribution width: can it be a predictive marker for long-term valvular involvement in children with acute rheumatic carditis? M. KUCUK*, R. OZDEMIR*, C. KARADENIZ*, K. CELEGEN † , M. DEMIROL*, M. M. YILMAZER*, T. MESE*, N. UNAL* *Division of Pediatric Cardiology, Izmir Dr. Behcet Uz Children’s Hospital, Izmir, Turkey † Department of Pediatrics, Izmir Dr. Behcet Uz Children’s Hospital, Izmir, Turkey Correspondence: Rahmi Ozdemir, Division of Pediatric Cardiology, Izmir Dr. Behcet Uz Children’s Hospital, 1374 st. no: 11, Alsancak 35220, Izmir, Turkey. Tel.: +902324116000; Fax: +902324892315, GSM: +905325487668; E-mail: rahmiozdemir35@gmail.com doi:10.1111/ijlh.12544 Received 4 March 2016; accepted for publication 25 May 2016 Keywords Children, rheumatic fever, carditis, rheumatic heart disease, red cell distribution width SUMMARY Introduction: In this study, we aimed to evaluate Red blood cell dis- tribution width (RDW) in patients with acute rheumatic carditis during the acute phase and after anti-inflammatory therapy. Methods: Pediatric patients diagnosed with acute rheumatic carditis (ARC) between 2006 and 2014 and age- and sex-matched controls were retrospectively analyzed. At the time of diagnosis and after 2 months of medical therapy, we reviewed the obtained demo- graphic features; echocardiographic data; complete blood count reports, including RDW; acute phase reactants, including C-reactive protein; and erythrocyte sedimentation rate values. Results: The number of the cases with ARC and age- and sex-matched controls were 100 and 110, respectively. The mean age of patients was 11.6 Æ 2.5 years. WBC and platelet counts, RDW were found to be significantly higher in patient group compared with controls at the time of diagnosis, prior to the onset of treatment. RDW, platelet count, CRP, and ESR levels significantly decreased after an 8 weeks of medical treatment. RDW values after the medical treatment were still significantly higher compared with controls. RDW values were significantly higher in patients with multiple valvular involvement both prior to and after the treatment. Moreover, we found a signifi- cant and positive correlation between the RDW and the severity of mitral regurgitation in our patients (r: 0.46, P < 0.001). Conclusions: High levels of RDW after initial medical treatment may indicate an ongoing subtle inflammatory process that leads to future stenotic valvular lesions. However, long-term follow-up studies are needed involving adulthood period to support this hypothesis. INTRODUCTION Rheumatic fever (RF) is an autoimmune inflamma- tory disease that typically develops following a ß-hemolytic group A streptococci infection in suscepti- ble individuals. Clinical manifestations of RF include polyarthritis, carditis, erythema marginatum, chorea, and subcutaneous nodules [1, 2]. © 2016 John Wiley & Sons Ltd, Int. Jnl. Lab. Hem. 1 ORIGINAL ARTICLE INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY International Journal of Laboratory Hematology The Official journal of the International Society for Laboratory Hematology