Anemia measurements to distinguish between viral and bacterial infections in the emergency department

Yael Steuerman, Asaf Wasserman, David Zeltser, Itzhak Shapira, Daniel Trotzky, Pinchas Halpern, Ahuva Meilik, Eli Raykhshtat, Shlomo Berliner, Ori Rogowski, Irit Gat-Viks, Shani Shenhar-Tsarfaty*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The clinical diagnosis of acute infections in the emergency department is a challenging task due to the similarity in symptom presentation between virally and bacterially infected individuals, while the use of routine laboratory tests for pathogen identification is often time-consuming and may contain contaminants. We investigated the ability of various anemia-related parameters, including hemoglobin, red cell distribution width (RDW), and iron, to differentiate between viral and bacterial infection in a retrospective study of 3883 patients admitted to the emergency department with a confirmed viral (n = 1238) or bacterial (n = 2645) infection based on either laboratory tests or microbiological cultures. The ratio between hemoglobin to RDW was found to be significant in distinguishing between virally and bacterially infected patients and outperformed other anemia measurements. Moreover, the predictive value of the ratio was high even in patients presenting with low C-reactive protein values (< 21 mg/L). We followed the dynamics of hemoglobin, RDW, and the ratio between them up to 72 h post emergency department admission, and observed a consistent discrepancy between virally and bacterially infected patients over time. Additional analysis demonstrated higher levels of ferritin and lower levels of iron in bacterially infected compared with virally infected patients. The anemia measurements were associated with length of hospital stay, where all higher levels, except for RDW, corresponded to a shorter hospitalization period. We highlighted the importance of various anemia measurements as an additional host-biomarker to discern virally from bacterially infected patients.

Original languageEnglish
Pages (from-to)2331-2339
Number of pages9
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Issue number12
StatePublished - 1 Dec 2019


  • Anemia
  • Bacterial infection
  • C-reactive protein
  • Emergency department
  • Red cell distribution width
  • Viral infection


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