Research - (2022) Volume 10, Issue 1

# Comparison of Haemoglobin, Red Cell Distribution Width and RBC Value in Normal and Oral Carcinoma Patients: A Retrospective Study

Harini M, Priyadharshini R^{*} and Palati Sinduja

** ^{*}Correspondence:**
Priyadharshini R, Department of Pathology, Saveetha Dental College and Hospitals, Saveetha Institutes of Medical and Technical Sciences (SIMATS), Saveetha University,
Chennai,
India,

**Email:**

## Abstract

Introduction: Oral squamous cell carcinoma is a cancer of the head and neck region affecting the various parts of the oral cavity such as the lining of the lips, mouth, upper part of the throat etc. Anaemia due to cancer comes under the category of anaemia caused due to chronic disease. Red Blood Cells are also known as erythrocytes, in most cancer patients are damaged due to the cancer treatments such as cancer chemotherapy, radiation therapy which damages and kills cancer cells. Studies regarding red cell count have concluded that there is a positive correlation between RBC count and cancer survival. Thus, this study aims at comparing and correlating the haemoglobin, RDW and RBC values of normal and oral squamous cell carcinoma patients. Materials and methods: Haematology reports of 10 normal patients and 10 oral squamous cell carcinoma patients were collected from Saveetha Dental College and Hospitals, Chennai from the patient record management system. The values of the parameters (haemoglobin, red cell distribution width and red cell value) were entered in an excel sheet and were imported to SPSS software for statistical analysis. The statistical test done was an independent t-test. Results and discussion: The data from the present study was collected and was statistically analysed using SPSS software. Inferring from the results of this study, the mean value of haemoglobin in the control group is 13.93 ± 2.8, the mean value of haemoglobin in the cancer group is 12.97 ± 5.0, the mean value of RDW in the control group is 12.51 ± 1.44, the mean value for RDW in cancer group is 12.86 ± 1.4, the mean value of RBC in the control group is 4.84 ± 0.9 and the mean value of RBC in cancer group is 4.59 ± 1.54. The P-value of haemoglobin is 0.135 (>0.05); p-value of RDW is 0.843 (0>0.05) and p-value of RBC is 0.429 (>0.05). Conclusion: This study showed no statistical significance among the haemoglobin, RDW and RBC values among cancer and control patients.

#### Keywords

Haemoglobin, RDW, RBC count, Novel method, Oral squamous cell carcinoma

#### Introduction

Oral squamous cell carcinoma is a cancer of the head and neck region affecting the various parts of the oral cavity such as the lining of the lips, mouth, upper part of the throat etc [1]. The carcinoma originates as a painless whitish patch which eventually develops to form a thickened red patch which continues to grow [2]. The main risk factors for oral cancer include tobacco, alcohol consumption, HPV infection, chewing betel nut and excess sun exposure. The treatments for oral cancer depend on the size of cancer, location and spread of cancer and it includes a combination of various surgeries such as radiation therapy, chemotherapy or targeted therapy [3]. Based on the epidemiology studies in 2012, more than three hundred patients have been affected with carcinoma in the oral cavity and the lip region which makes oral cancer one of the most prevalent cancers to occur [4].

Anaemia is the most related complication in all types of cancer and is known to reduce the quality of life [5]. Anaemia due to cancer comes under the category of anaemia caused due to chronic disease and this is a result of the production of disease-stimulated inflammatory cytokines such as interleukin-1, TNF (tumour necrosis factor), interferons etc. which leads to the inhibition of erythropoiesis due to the reduction in erythropoietin production and impairing the use of iron [6]. Increasing evidence has been obtained which suggests the correlation of anaemia and poor prognosis in cancer patients [7].

Red Cell Distribution Width (RDW) is a parameter that gives the size heterogeneity of the red blood cell and usually helps in differentiating the various types of anaemia [8]. RDW is also known to primarily reflect impaired erythropoiesis and abnormal red cell survival. It also correlates with other factors such as inflammation, nutritional disorders, impaired kidney function and prediction of various forms of carcinoma [9]. Studies conducted regarding the association of RDW with cancer resulted that there exists a positive correlation between a higher RDW value and increased mortality risk (for every 1% increase in RDW, the mortality rate increased by 14%) [10]. Red Blood Cells are also known as erythrocytes, in most cancer patients are damaged due to the cancer treatments such as cancer chemotherapy, radiation therapy which damages and kills cancer cells. Low levels of RBC often show symptoms like fatigue, shortness of breath, light-headedness, increased heart rate, headaches etc. Studies regarding red cell count have concluded that there is a positive correlation between RBC count and cancer survival [11]. Our team has extensive knowledge and research experience that has translated into high quality publications [12-31]. Thus, this study aims at comparing and correlating the haemoglobin, RDW and RBC values of normal and oral squamous cell carcinoma patients.

#### Materials and Methods

Haematology reports of 10 normal patients and 10 oral squamous cell carcinoma patients were collected from Saveetha Dental College and Hospitals, Chennai from the patient record management system. Before the initiation of the study, clearance was obtained by the Scientific Review Board with ethical approval number IHEC/SDC/BDS/1996/01. The values of the parameters (haemoglobin, red cell distribution width and red cell value) along with the age, gender, treatment is given, grading and staging of the cancer patients were entered in an excel sheet and were imported to SPSS software for statistical analysis. The statistical test done was an independent t-test.

#### Discussion

The data from the present study was collected and was
statistically analysed using SPSS software. Inferring from
the results of this study, the mean value of haemoglobin
in the control group is 13.93 ± 2.8 and the mean value of
haemoglobin in the cancer group is 12.97 ± 5.0 (**Table 2**)
The mean difference is -0.960. Since there exists a mean
difference between the control and the cancer groups, an
independent t-test was done which revealed the p-value
to be 0.135 (>0.05) (**Table 3**). Therefore, it is statistically
insignificant. A study done by M Lind et al., comparing
the haemoglobin level in cancer and control patients
revealed that there is a marked reduction in the
haemoglobin level of the cancer group compared to the
control group (mean=10.66 ± 2.08) and the P-value
<0.05, proving it statistically significant [32]. Groopman
et al. conducted a similar study but concluded with
contrasting results. The mean value of haemoglobin in
cancer patients was found to be 12.56 ± 8.6 and the pvalue
was greater than 0.05 deeming it statistically
insignificant [33].

**Figure 1:** Bar chart representing the correlation
between the groups (control and cancer) and the
parameters where blue denotes ‘haemoglobin’, green
denotes ‘RDW’ and yellow denotes ‘RBC’. The X-axis
represents the groups and Y-axis represents the
percentage distribution of the mean (%). The mean
value of haemoglobin in the control group is 13.93 ±
2.8, the mean value of haemoglobin in the cancer
group is 12.97 ± 5.0, the mean value of RDW in the
control group is 12.51 ± 1.44, the mean value for
RDW in the cancer group is 12.86 ± 1.4, the mean
value of RBC in the control group is 4.84 ± 0.9 and the
mean value of RBC in cancer group is 4.59 ± 1.54.

**Figure 2:** Bar chart representing the percentage of
population in the groups (control and cancer) and
the genders where blue denotes ‘male’ and green
denotes female. The X-axis represents the group and
the Y-axis represents the percentage distribution of
the population (%).

**Figure 3:** Bar chart representing the percentage of
samples in each group and the age and the study
population where blue denotes ‘30-40 years’, green
denotes ‘41-50 years’ and yellow denotes ‘51-60’
years. The X-axis represents the control and cancer
group and Y-axis represents the percentage
distribution of the number of samples (%).

Literature | Haemoglobin | RDW | RBC | P-Value |
---|---|---|---|---|

Qin, al. [34] | - | 13.78 ± 2.38 | - | P<0.05 |

Lind et al. [32] | 10.66 ± 2.08 | - | - | P<0.05 |

Brundha et al. [36] | - | - | 4.35 ± 1.1 | P>0.05 |

Groopman et al. [33] | 12.56 ± 8.6 | - | 4.66 ± 15.2 | P>0.05 |

Montagnana et al. [35] | - | 13.89 ± 1.34 | - | P<0.05 |

Present Study | 12.97 ± 5.0 | 12.86 ± 1.4 | 4.59 ± 1.54 | P>0.05 |

**Table 1: **Table showing the haemoglobin, RDW, RBC and P values obtained from previous literature.

Group statistics | |||||
---|---|---|---|---|---|

Groups | N | Mean | Std. Deviation | Std. Error mean | |

HB | Control | 10 | 13.93 | 1.40004 | 0.44273 |

Cancer | 10 | 12.97 | 2.59746 | 0.82139 | |

RDW | Control | 10 | 12.51 | 0.72946 | 0.23068 |

Cancer | 10 | 12.86 | 0.70427 | 0.22271 | |

RBC | Control | 10 | 4.849 | 0.45598 | 0.14419 |

Cancer | 10 | 4.595 | 0.77855 | 0.2462 |

**Table 2: **showing the group statistics for haemoglobin, RDW and RBC value. The mean value of haemoglobin in the control group is 13.93 ± 2.8, the mean value of haemoglobin in the cancer group is 12.97 ± 5.0, the mean value of RDW in the control group is 12.51 ± 1.44, the mean value for RDW in the cancer group is 12.86 ± 1.4, the mean value of RBC in the control group is 4.84 ± 0.9 and the mean value of RBC in cancer group is 4.59 ± 1.54.

Parameter | Independent T Test (P Value) |
---|---|

Haemoglobin | 0.135 |

RDW | 0.843 |

RBC | 0.429 |

**Table 3:** Shows the P-value of the parameter’s haemoglobin, RDW and RBC value. The P-value of haemoglobin is 0.135, the p-value of RDW is 0.843 and the p-value of RBC is 0.429.

The mean value of RDW in the control group is 12.51 ±
1.44and the mean value for RDW in the cancer group is
12.86 ± 1.4. The mean difference is 0.350. Since there
exists a mean difference between the control and the
cancer groups, an independent t-test was done which
revealed the p-value to be 0.843 (>0.05) (**Table 3**). Hence,
it is statistically insignificant. In a study on the value of
red cell distribution width in patients with ovarian
cancer and compared the RDW value of the cancer group
and control group which resulted in the mean value of
13.78 ± 2.83 and a p-value of < 0.05 hence, statistically
significant. [34]. (**Table 1**) A study by Martina
Montagnana et al. done regarding the RDW in cancer and
control patients resulted in a mean value of 13.89 ± 1.34 and p-value < 0.05. [35]. Hence, the RDW value among
cancer and control group in both previous studies were
statistically significant which is contrasting from the
results obtained in this present study.

The mean value of RBC in the control group is 4.84 ± 0.9
and the mean value of RBC in the cancer group is 4.59 ±
1.54 (**Table 2**). The mean difference is -0.250. There
exists a difference, hence an independent t-test was done
which revealed the p-value to be 0.429 (>0.05). Hence, it
is statistically insignificant. A study by M.P. Brundha et al.
about the red cell count in cancer patients, resulted in a
mean value of 4.35 ± 1.1 and p-value >0.05. Hence, it is
statistically insignificant [36]. (**Table 1**) The mean value
of RBC count in a study by Groopman et al. was found to
be 4.66 ± 15.2 and a p-value >0.05 therefore it is
statistically insignificant [33]. Hence, both the previous
literature had concluded that the RBC value in cancer and
control group was statistically insignificant.

This present study compared the values of the parameters, haemoglobin, RDW and RBC of cancer and control groups whereas the previous literature has discussed only any one of the parameters. This study had a smaller sample size of only 20 patients among which only 10 were oral cancer patients which is a limitation. Further, the surgical and chemotherapeutic details were not included in this study. In the future, further studies regarding these parameters and their significance in cancer patients could be done with a bigger sample size which could provide better and more accurate results.

#### Conclusion

In this study, the haemoglobin and RBC count of the cancer patients were decreased compared to the control group but were statistically insignificant. The RDW value of cancer patients was increased compared to the control group but also showed no statistical insignificance. In conclusion, this study showed no statistically significant difference among the haemoglobin, RDW and RBC values between cancer and control patients.

#### Acknowledgement

We thank Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Saveetha University for supporting us to conduct the study.

#### Source of Funding

The present project is supported by

• Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Saveetha University, India

• Sarkav Health Services, Chennai, India

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#### Author Info

Harini M, Priyadharshini R^{*} and Palati Sinduja

**Received: **13-Dec-2021, Manuscript No. Jrmds-21-41705;
, Pre QC No. Jrmds-21-41705 (PQ);
**Editor assigned: **15-Dec-2021, Pre QC No. Jrmds-21-41705 (PQ);
**Reviewed: **29-Dec-2021, QC No. Jrmds-21-41705;
**Revised: **03-Jan-2022, Manuscript No. Jrmds-21-41705 (R);
**Published:**
10-Jan-2022