RDW Blood Test High? Why Your Red Cells Vary & Medically Approved Next Steps

If your RDW blood test came back high, you're not alone. RDW—short for Red Cell Distribution Width—is a common part of a complete blood count (CBC). It measures how much your red blood cells vary in size.

A high RDW doesn't automatically mean something serious. But it does mean your red blood cells aren't all the same size, and that can point to underlying health issues that deserve attention.

Let's break down what this means, what causes it, and what you should do next.

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What Is the RDW Blood Test?

The RDW blood test measures variation in the size (volume) of your red blood cells.

• Normal red blood cells are fairly uniform in size.
• RDW shows how much they differ from each other.
• It's usually reported as a percentage.
• Most labs consider a normal RDW range to be about 11% to 15%, though ranges may vary slightly.

RDW is not typically interpreted alone. Doctors look at it alongside other values in your CBC, especially:

• Hemoglobin
• Hematocrit
• MCV (Mean Corpuscular Volume) – average size of red blood cells

Together, these results help identify types of anemia and other blood conditions.

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What Does a High RDW Blood Test Mean?

A high RDW blood test means there is more variation in red blood cell size than normal. Some cells may be small, some large.

This condition is called anisocytosis.

A high RDW can signal that your body is:

• Not producing healthy red blood cells efficiently
• Recovering from blood loss
• Lacking certain nutrients
• Experiencing chronic inflammation or disease

It's important to note:

A high RDW is a clue — not a diagnosis.

Your doctor will interpret it in context.

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Common Causes of High RDW

1. Iron Deficiency Anemia (Most Common)

Iron deficiency is one of the most frequent reasons for a high RDW blood test.

When iron is low:

• New red blood cells become smaller than normal.
• Older cells remain normal size.
• This size difference raises RDW.

Common causes of iron deficiency:

• Heavy menstrual bleeding
• Gastrointestinal bleeding
• Poor diet
• Pregnancy
• Chronic blood loss

Symptoms may include:

• Fatigue
• Pale skin
• Shortness of breath
• Dizziness
• Brittle nails

If these symptoms sound familiar, you can use a free AI-powered Anemia symptom checker to assess your individual risk factors and symptoms in just a few minutes.

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2. Vitamin B12 or Folate Deficiency

These deficiencies cause the body to produce larger-than-normal red blood cells.

When mixed with normal cells, RDW increases.

Possible symptoms:

• Weakness
• Tingling in hands or feet
• Memory problems
• Smooth or sore tongue

These deficiencies are treatable, but if left untreated, B12 deficiency can cause nerve damage.

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3. Mixed Anemia

Some people have more than one type of anemia at the same time, such as:

• Iron deficiency + B12 deficiency
• Iron deficiency + chronic disease

This combination often leads to significantly elevated RDW.

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4. Chronic Disease or Inflammation

Long-term conditions like:

• Kidney disease
• Autoimmune disorders
• Chronic infections

can interfere with red blood cell production and cause RDW changes.

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5. Recent Blood Loss or Recovery

If you've:

• Had surgery
• Experienced trauma
• Donated blood

Your bone marrow may release new red blood cells rapidly, increasing variation in size temporarily.

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6. Liver Disease

Liver problems can affect red blood cell shape and size, sometimes raising RDW.

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7. Bone Marrow Disorders (Less Common but Serious)

Rarely, a high RDW blood test may be linked to:

• Myelodysplastic syndromes
• Other bone marrow disorders

These are uncommon, but they require medical evaluation if suspected.

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What If RDW Is High but Everything Else Is Normal?

This situation happens.

If:

• Hemoglobin is normal
• MCV is normal
• You have no symptoms

Your doctor may simply monitor it.

Sometimes RDW rises before anemia develops, making it an early warning sign. In these cases, follow-up testing is important.

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What Are the Next Medically Approved Steps?

If your RDW blood test is high, here's what typically happens next:

1. Review the Full CBC

Your doctor will look at:

• Hemoglobin
• MCV
• RBC count
• Platelets

This helps determine whether anemia is present and what type.

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2. Order Additional Blood Tests

Depending on your results, your doctor may check:

• Iron levels
• Ferritin (iron storage)
• Vitamin B12
• Folate
• Reticulocyte count
• Kidney function
• Thyroid function

These tests pinpoint the root cause.

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3. Treat the Underlying Cause

Treatment depends on what's found:

• Iron deficiency: Iron supplements and dietary changes
• B12 deficiency: Oral supplements or injections
• Folate deficiency: Folic acid supplementation
• Chronic disease: Managing the underlying condition

Never start high-dose supplements without medical guidance. Too much iron or B12 can cause problems.

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4. Monitor Over Time

After treatment begins, doctors often repeat the CBC in:

• 4–8 weeks

RDW may take time to normalize as new healthy red blood cells replace older ones.

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When Is a High RDW Dangerous?

Most causes are treatable and not immediately life-threatening.

However, seek urgent medical care if you experience:

• Severe shortness of breath
• Chest pain
• Fainting
• Rapid heartbeat
• Extreme weakness
• Signs of internal bleeding (black stools, vomiting blood)

These symptoms may indicate severe anemia or another serious condition.

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Can You Lower RDW Naturally?

If the cause is nutritional, lifestyle changes can help:

Iron-rich foods:

• Lean red meat
• Spinach
• Lentils
• Fortified cereals

Vitamin B12 sources:

• Meat
• Fish
• Eggs
• Dairy

Folate sources:

• Leafy greens
• Beans
• Citrus fruits

If your RDW blood test is high due to diet, correcting deficiencies often improves levels.

But diet alone won't fix RDW if the issue is chronic disease or blood loss — medical evaluation is essential.

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Key Takeaways About a High RDW Blood Test

• RDW measures variation in red blood cell size.
• A high RDW blood test often points to anemia, especially iron deficiency.
• It must be interpreted alongside other blood test results.
• Many causes are treatable.
• Serious causes are rare but should not be ignored.

If you're experiencing fatigue, weakness, or other concerning symptoms alongside your high RDW result, try this free AI-powered Anemia symptom checker to help you prepare for your doctor's appointment with personalized insights.

Most importantly:

Speak to a doctor about your results — especially if you have symptoms or abnormal lab findings. Some causes of high RDW can become serious if untreated.

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The Bottom Line

A high RDW blood test is a signal, not a verdict. It tells your doctor that your red blood cells vary in size — and that something may be affecting how they're produced.

In many cases, the cause is straightforward and treatable, such as iron deficiency. In other cases, further testing is needed.

Don't panic — but don't ignore it either.

Review your full lab report, assess your symptoms, and speak to a doctor to determine the next appropriate steps. Early action leads to better outcomes.