Diagnostic reliability check of red cell indices in differentiating Iron Deficiency Anemia (IDA) from Beta Thalassemia Minor (BTT) (original) (raw)
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Iron Deficiency Anemia and β-Thalassemia Minor Differantiation With Hematological Indices
2019
Objective: Iron Deficiency Anemia (IDA) and Beta Thalassemia Minor (BTM) are the most common causes of microcytic hypochromic anemia. In the last four decades many formulas have been proposed to discriminate between two common causes of microcytic hypochromic anemia. An ideal discrimination index should have a high sensitivity and specificity and should be easy to calculate. The distinction between IDA and BTM is important in many respects. In our study, the performance of twelve indices were tested to distinguish IDA from BTM, two common causes of microcytic anemia. Materials and methods: There were two groups which were evaluated as IDA and BTM, we examined the diagnostic accuracy of five red cell parameters [red blood cell (RBC), mean corpuscular volume (MCV), hemoglobin (Hb) ,mean corpuscular hemoglobin (MCH), red blood cell distribution width (RDW)] and we calculated twelve indices [Menzier Index (MI), Green and King (GK), Red Blood Cell Distribution Width Index (RDWI), England...
Most reliable indices in differentiation between thalassemia trait and iron deficiency anemia
Pediatrics International, 2002
Background : Iron deficiency anemia (IDA) and thalassemia trait (TT) are the most common forms of microcytic anemia. Some discrimination indices calculated from red blood cell indices are defined and used for rapid discrimination between TT and IDA. However, there has been no study carried out in which the validity of all of the defined indices are compared in the same patient groups. Youden's index is the most reliable method by which to measure the validity of a particular technique, because it takes into account both sensitivity and specificity. Methods : We calculated eight discrimination indices (Mentzer Index, England and Fraser Index, Srivastava Index, Green and King Index, Shine and Lal Index, red blood cell (RBC) count, red blood cell distribution width and red blood cell blood distribution width index (RDWI)) in 26 patients with IDA and in 37 patients with beta TT ( β TT). We determined the number of correctly identified patients by using each discrimination index. We also calculated sensitivity, specificity, positive and negative predictive value and Youden's index of each discrimination index. Results : None of the discrimination indices showed a sensitivity and specificity of 100%. Youden's indices of RBC count and RDWI were the highest with the value of 82 and 80%, respectively. Ninety percent and 92% of the patients were correctly identified with RBC and RDWI, respectively. Conclusion : Red blood cell count and RDWI are the most reliable discrimination indices in differentiation between β TT and IDA.
International journal of hematology-oncology and stem cell research, 2014
The two most frequent hypochromic microcytic anemias are β- thalassemia minor (BTM) and iron deficiency anemia (IDA). Several discrimination indices have been proposed to quickly discriminate these similar entities via parameters obtained from automated blood count analyzers. The aim of this study to evaluate the diagnostic reliability of ten discrimination indices in the differentiation of Iron deficiency anemia (IDA) from β Thalassemia Minor (BTM). This study was conducted on 100 BTM and 70 cases with IDA in southern Iran. This evaluation was conducted through calculation sensitivity, specificity, positive and negative predictive value, Likelihood ratio positive, likelihood ratio negative and also we recalculated cut-off values for every formulas in our population and determination of Area Under Curve related to receiver operative characteristic (ROC) curves. ROC for each discrimination indices show that, the highest diagnostic value based on the area under the ROC curve are relat...
European Journal of Haematology, 2007
Objectives: Iron deficiency anemia (IDA) and beta-thalassemia trait (B-TT) are the most common causes of hypochromic microcytic anemias. Many indices have been defined to quickly discriminate these similar entities via parameters obtained from automated blood count analyzers. The purpose of the study was to evaluate the predictive value of these indices in differential diagnosis of IDA and B-TT in adult cases.Methods: This study consists of 45 IDA cases, 36 women and nine men, whose mean age is 33.87 ± 11.59 (mean ± SD) (range 17–57 yr) and 66 B-TT cases, 41 women and 25 men, whose mean age is 33.26 ± 13.36 (mean ± SD) (range 14–74 yr). IDA cases with Hb value <8.7 g/dL have been excluded because these cases are not confused with B-TT cases in practice. Patient groups have been evaluated according to red blood cell (RBC), red blood cell distribution width (RDW), Mentzer index, Shine and Lal indices, England and Fraser indices, Srivastava index, Green and King indices, RDW index and Ricerca index. Sensitivity, specificity, positive and negative predictive values and Youden’s index have been calculated.Results: Finally, none of these different formulations are superior to RBC value obtained from automated analyzers in adult cases with IDA and B-TT.Conclusions: Total body iron status and hemoglobin A2 level should be obtained for accurate differential diagnosis of IDA and B-TT until more efficient tools develop.
Objective: Iron deficiency anemia (IDA) and beta-thalassemia trait (ß-TT) are the most common forms of microcytic anemia. This study was conducted to compare the validity of various discrimination indices in differentiating β-TT from IDA by calculating their sensitivity, specificity and Youden's index. Methods: Totally 323 subjects (173 children and 150 adults) with microcytic anemia were involved in this study. We calculated 10 discrimination indices in all patients with IDA and β-TT. We divided the patients into two different groups as younger or older than 10 years. Results: None of the indices showed sensitivity and specificity of 100% in the patients older than 10 years, and in the patients younger than 10 years, only Shine & Lal index showed sensitivity close to 90% and specificity of 100%. The most accurate discriminative index for patients younger than 10 years was Shine & Lal and for those older than 10 years it was RDW index. According to Youden's index, Shine & Lal and RBC count showed the greatest diagnostic value in patients younger than 10 years and RDW and RBC count indices in those older than 10 years. Conclusion: None of the indices was completely sensitive and specific in differentiation between β-TT and IDA. Mean and median mean cell Hb density (MCHD) were very close to normal values in both IDA and β-TT patients, but in the case of mean density of Hb/liter (MDHL), we found that the mean and median were significantly higher than normal values in β-TT and lower than normal values in IDA patients. In our study, Youden's index of RBC and Shine & Lal were the highest and most reliable indices in differentiating β-TT from IDA in the patients younger than 10 years. For patients older than 10 years, the most reliable discrimination indices were RBC and RDW. (Turk J Hematol 2009; 26: 138-45)
One of the most common causes of microcytic hypochromic anemia is either “Iron Deficiency” or “β-thalassemia trait”. It is a major diagnostic consideration to distinguish between the two. There are many formulas or indices that can discriminate similar CBC entities obtained via hematological cell analyzers. The aim of our study was to differentiate β-thalassemia trait from IDA on the basis of Mentzer’s Index and Red cell Distribution Width (RDW).
International Journal of Biomedicine, 2022
Background: Iron deficiency anemia (IDA) and beta-thalassemia trait (BTT) are the most common types of microcytic hypochromic anemias. The aim of this study was to evaluate the reliability of different RBC indices for discrimination between IDA and BTT in Sudanese patients. Methods and Results: This cross-sectional laboratory-based study was conducted among 200 patients (100 patients suffering from BTT and 100 from IDA) who attended the public health hospitals of Khartoum State (Sudan), from Jan 2021 to Feb 2022. The diagnosis of BTT was based on CBC and hemoglobin electrophoresis, and was confirmed by PCR. The diagnosis of IDA was based on complete blood count, reduced serum iron levels, and ferritin levels. Pregnant women, patients who had received a blood transfusion within three months of the study, and patients with thalassemia coexisting with IDA or other hemoglobinopathies were excluded from the study. A series of red blood cell indices were analyzed to differentiate IDA and BTT. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index (J) were calculated for each index. In BTT and IDA patients, mean values of Hb, hematocrit, and mean corpuscular volume were 10.9g/dL, 33.96%, 59.11fL, and 8.5g/dL, 26%, 68fL, respectively. All RBC indices were decreased in BTT and IDA. Mean RBC count was increased in BTT while showing normal values in IDA. In BTT patients, hemoglobin electrophoresis showed high HbA 2 (6.4%) and HbF (1.95%) but a decreased HbA (78.2%). Conclusion: The best discrimination index according to J was Mentzer index (0.85), followed by Sidrah index (0.83), Ehsani index (0.81), RBC count (0.80), RDWI (0.79), Green and King index (0.76), MDHL (o.76), Srivastava index (o.76), and England and Fraser index (0.7). The lowest J was presented in Ricerca index (0.45), Shine and Lal index (0.01), and MCHD (0).
Anemia, 2014
Background. The two most frequent types of microcytic anemia are beta thalassemia trait (β-TT) and iron deficiency anemia (IDA). We retrospectively evaluated the reliability of various indices for differential diagnosis of microcytosis andβ-TT in the same patient groups.Methods. A total of 290 carefully selected children aged 1.1–16 years were evaluated. We calculated 12 discrimination indices in all patients with hemoglobin (Hb) values of 8.7–11.4 g/dL. None of the subjects had a combined case of IDA andβ-TT. All children with IDA received oral iron for 16 weeks, and HbA2 screening was performed after iron therapy. The patient groups were evaluated according to red blood cell (RBC) count; red blood distribution width index; the Mentzer, Shine and Lal, England and Fraser, Srivastava and Bevington, Green and King, Ricerca, Sirdah, and Ehsani indices; mean density of hemoglobin/liter of blood; and mean cell density of hemoglobin.Results. The Mentzer index was the most reliable index, ...
JPMA. The Journal of the Pakistan Medical Association, 2016
To assess the reliability of different red blood cell indices-based formulae in the indexes formula in differential diagnosis of beta thalassemia trait and iron deficiency anaemia. This cross-sectional study was conducted between January and October 2015 in Dera Ismail Khan in the Khyber Pakhtunkhwa province of Pakistan. Patients of beta thalassemia trait and iron deficiency anaemia were registered irrespective of age and gender. About 5 mL of blood was taken from each patient to analyse different red cell parameters like red blood cell count, haemoglobin, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, and red cell distribution width. Five formulae were used to discriminate between the two conditions. These were red cell distribution width index, Shine and Lal index, Mentzer index, Srivastava index, and the Green and King index. Sensitivity, specificity, positive and negative predictive values and Youden's index of all the indices were calculated. ...
Clinical Chemistry and Laboratory Medicine, 2016
Background: More than 40 mathematical indices have been proposed in the hematological literature for discriminating between iron deficiency anemia and thalassemia trait in subjects with microcytic red blood cells (RBCs). None of these discriminant indices is 100% sensitive and specific and also the ranking of the discriminant indices is not consistent. Therefore, we decided to conduct the first meta-analysis of the most frequently used discriminant indices. Methods: An extensive literature search yielded 99 articles dealing with 12 indices that were investigated five or more times. For each discriminant index we calculated the diagnostic odds ratio (DOR) and summary ROC analysis was done for comparing the performance of the indices. Results: The ratio of microcytic to hypochromic RBCs (M/H ratio) showed the best performance, DOR = 100.8. This was significantly higher than that of all other indices investigated. The RBC index scored second (DOR = 47.0), closely followed by the Sirdah index (DOR = 46.7) and the Ehsani index (DOR = 44.7). Subsequently, there was a group of four indices with intermediate and three with lower DOR. The lowest performance (DOR = 6.8) was found for the RDW (Bessman index). Overall, the indices performed better for adults than for children. Conclusions: The M/H ratio outperformed all other discriminant indices for discriminating between iron deficiency anemia and thalassemia trait. Although its sensitivity and specificity are not high enough for making a definitive diagnosis, it is certainly of value for identifying those subjects with microcytic RBC in whom diagnostic tests for confirming thalassemia are indicated.