Multivariable Discriminant Analysis for the Differential Diagnosis of Microcytic Anemia

Introduction. Iron deficiency anemia and thalassemia are the most common causes of microcytic anemia. Powerful statistical computer programming enables sensitive discriminant analyses to aid in the diagnosis. We aimed at investigating the performance of the multiple discriminant analysis (MDA) to the differential diagnosis of microcytic anemia.Methods. The training group was composed of 200β-thalassemia carriers, 65α-thalassemia carriers, 170 iron deficiency anemia (IDA), and 45 mixed cases of thalassemia and acute phase response or iron deficiency. A set of potential predictor parameters that could detect differences among groups were selected: Red Blood Cells (RBC), hemoglobin (Hb), mean cell volume (MCV), mean cell hemoglobin (MCH), and RBC distribution width (RDW). The functions obtained with MDA analysis were applied to a set of 628 consecutive patients with microcytic anemia.Results. For classifying patients into two groups (genetic anemia and acquired anemia), only one function was needed; 87.9%β-thalassemia carriers, and 83.3%α-thalassemia carriers, and 72.1% in the mixed group were correctly classified.Conclusion. Linear discriminant functions based on hemogram data can aid in differentiating between IDA and thalassemia, so samples can be efficiently selected for further analysis to confirm the presence of genetic anemia.

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Hematological Indices for Differential Diagnosis of Beta Thalassemia Trait and Iron Deficiency Anemia

Anemia ◽

10.1155/2014/576738 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 22

Author(s):

Aysel Vehapoglu ◽

Gamze Ozgurhan ◽

Ayşegul Dogan Demir ◽

Selcuk Uzuner ◽

Mustafa Atilla Nursoy ◽

...

Keyword(s):

Differential Diagnosis ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Beta Thalassemia ◽

Distribution Width ◽

Patient Groups ◽

Thalassemia Trait ◽

Rbc Count

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, as it had the highest sensitivity (98.7%), specificity (82.3%), and Youden’s index (81%) for detectingβ-TT; this was followed by the Ehsani index (94.8%, 73.5%, and 68.3%, resp.) and RBC count (94.8%, 70.5%, and 65.3%).Conclusion. The Mentzer index provided the highest reliabilities for differentiatingβ-TT from IDA.

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Comparison of red cell distribution width and a red cell discriminant function incorporating volume dispersion for distinguishing iron deficiency from beta thalassemia trait in patients with microcytosis

Sao Paulo Medical Journal ◽

10.1590/s1516-31801996000500005 ◽

1996 ◽

Vol 114 (5) ◽

pp. 1265-1269 ◽

Cited By ~ 8

Author(s):

Carmen Silvia Passos Lima ◽

Aparecida Ribeiro de Carvalho Reis ◽

Helena Zerlotti Wolf Grotto ◽

Sara Teresinha Ollala Saad ◽

Fernando Ferreira Costa

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Discriminant Function ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Beta Thalassemia ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Thalassemia Trait

The red cell distribution width (RDW), and another red cell discriminant function incorporating RDW (MCV² x RDW/Hgb x 100) were determined in a group of 30 patients with iron deficiency anemia, 30 patients with beta thalassemia trait, and 30 normal subjects. Both RDW and (MCV² x RDW/Hgb x 100) mean values were significantly higher in iron deficiency anemia than in beta thalassemia trait (p<0.001). Taking RDW equal or above 21.0 percent among microcytic anemia patients, we identified correctly 90.0 percent of patients with iron deficiency anemia. The sensitivity and specificity of the test were 90.0 percent (IC 95 percent: 0.75 - 0.96) and 77.0 percent (IC 95 percent: 0.60 - 0.88), respectively. RDW values below 21.0 percent identified correctly 77.0 percent of beta thalassemia trait with a sensitivity and a specificity of 77.0 percent (IC 95 percent: 0.60 - 0.88) and 90.0 percent (IC 95 percent: 0.75 - 0.96), respectively. Taking values of (MCV² x RDW/Hgb x 100) above and below 80.0 percent as indicative of iron deficiency and beta thalassemia trait, respectively, we identified correctly 97.0 percent of those patients in each group. Both sensitivity and specificity were 97.0 percent (IC 95 percent: 0.84 - 0.99). These results indicated that the red cell discriminant function incorporating volume dispersion (MCV² x RDW/Hgb x 100) is a highly sensitive and specific method in the initial screening of patients with microcytic anemia and is better than RDW in differentiating iron deficiency anemia from beta thalassemia trait.

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Microcytic anemia: Differential Diagnosis and Management of Iron Deficiency Anemia

Medical Clinics of North America ◽

10.1016/s0025-7125(16)30339-x ◽

1992 ◽

Vol 76 (3) ◽

pp. 549-566 ◽

Cited By ~ 48

Author(s):

Ann C. Massey

Keyword(s):

Differential Diagnosis ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Diagnosis And Management

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Verification of 20 Mathematical Formulas for Discriminating Between Iron Deficiency Anemia and Thalassemia Trait in Microcytic Anemia

Laboratory Medicine ◽

10.1093/labmed/lmaa030 ◽

2020 ◽

Vol 51 (6) ◽

pp. 628-634 ◽

Cited By ~ 2

Author(s):

Johannes J M L Hoffmann ◽

Eloísa Urrechaga

Keyword(s):

Iron Deficiency ◽

Operating Characteristic ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Mean Cell Volume ◽

Distribution Width ◽

Independent Verification ◽

Mathematical Formulas ◽

Thalassemia Trait ◽

Discriminant Power

Abstract Background Currently, more than 45 mathematical formulas based on simple red blood cell (RBC) parameters have been proposed for differentiating between iron deficiency and thalassemia in microcytic anemia, of which 20 are relatively new and have not been thoroughly independently verified. The study goal was to verify these 20 new formulas and to identify which RBC parameters have a decisive impact on the performance of those formulas. Methods A database containing laboratory and diagnostic data from 2788 subject individuals with microcytic anemia was used for assessing performance by receiver operating characteristic (ROC) analysis. Results The new Index26 had excellent performance, equivalent to the Green and King, Jayabose, and Janel formulas previously identified in the literature. The discriminant power of nearly all newer formulas was lower in our study than that claimed by the original authors. We discovered that a well-performing formula requires mean cell volume (MCV), RBC distribution width (RDW), and RBC measurements, whereas hemoglobin measurements appeared not to be essential. Conclusions Only the new Index26 performed at a level comparable to the very strongest established formulas. All other new formulas had lower performance than was claimed in the original publications, underscoring that independent verification of new formulas is indispensable.

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Discriminant indexes to simplify the differential diagnosis between iron deficiency anemia and thalassemia minor in individuals with microcytic anemia

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.66.9.1277 ◽

2020 ◽

Vol 66 (9) ◽

pp. 1277-1282

Author(s):

Fernando Minervo Pimentel Reis ◽

Raul Ribeiro de Andrade ◽

Célio Fernando de Sousa Rodrigues ◽

Fabiano Timbó Barbosa

Keyword(s):

Differential Diagnosis ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Cross Sectional ◽

Require Time ◽

Additional Tool ◽

Thalassemia Minor ◽

Confirmatory Tests

SUMMARY INTRODUCTION: Microcytic anemias are very common in clinical practice, with iron deficiency anemia (IDA) and thalassemia minor (TT) being the most prevalent. Diagnostic confirmation of these clinical entities requires tests involving iron metabolism profile, hemoglobin electrophoresis, and molecular analysis. In this context, several discriminant indices have been proposed to simplify the differential diagnosis between IDA and TM. OBJECTIVE: The aim of this paper was to demonstrate the clinical relevance of the use of discriminant indices in individuals with microcytic anemia to simplify the differential diagnosis between iron deficiency anemia and minor thalassemia. METHODS: A bibliographic and cross-sectional search was performed in the PubMed, SciELO and LILACS databases, using the following descriptors: iron deficiency anemia, thalassemia minor, and differential diagnosis. RESULTS: More than 40 mathematical indices based on erythrocyte parameters have been proposed in the hematological literature in individuals with microcytosis. Green & King indexes (IGK), Ehsani index, and erythrocyte count (RBC) had excellent performances, especially when their efficacy was observed in adults and children. CONCLUSIONS: Confirmatory tests for differential diagnosis between IDA and TM require time-consuming and costly methods. Despite the excellent performances of IGK, Ehsani index, and RBC, none of them presented sufficient sensitivity and specificity to establish a diagnosis. However, they can provide a powerful additional tool for diagnostic simplification between IDA and TM.

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Reticulocyte hemoglobin equivalent in differential diagnosis of iron deficiency, iron deficiency anemia and β thalassemia trait in children.

Turkish Journal of Biochemistry ◽

10.1515/tjb-2020-0277 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Yeter Düzenli Kar ◽

Konca Altınkaynak

Keyword(s):

Differential Diagnosis ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Roc Analysis ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Healthy Children ◽

Hypochromic Microcytic Anemia ◽

Thalassemia Trait ◽

Diagnostic Power

AbstractObjectivesThis study investigated the diagnostic power of reticulocyte hemoglobin equivalent (Ret-He) in the differential diagnosis of hypochromic microcytic anemia to differentiate iron deficiency anemia (IDA) and thalassemia trait (TT) based on the traditionally used erythrocyte index and formulas.MethodsTwenty-six children with iron deficiency (ID), 26 with IDA, 33 with β-TT, 41 healthy children were assessed. Complete blood count parameters, Ret-He, immature reticulocyte fraction (IRF), low-fluorescence ratio (LFR), Mentzer’s indexes (MI) were evaluated. The diagnostic power of Ret-He in distinguishing between IDA and β-TT was investigated using ROC analysis.ResultsRet-He levels were (median(Q1-Q3)) 20.6(19.7–21.5) pg in β-TT, 16.1(13.1–20) pg in IDA, 29.7(27.2–30.7) pg in ID, 30.5(29.8–31.7) pg in healthy controls. Based on ROC analysis, diagnostic power for distinguishing between IDA and β-TT was determined as RBC>MI>Ret-He>RDW>LFR>IRF. The highest sensitivity and specificity for differential diagnosis was obtained when the Ret-He cut-off value was 18.2pg. The AUC (95%CI) value was calculated as 0.765(0.637–0.866), and a statistically significant difference was found between groups (p<0.0006).ConclusionsIn patients with hypochromic microcytic anemia, Ret-He≤18.2pg combined with RBC≤5.3x106/L and MI>10.42 can be safely used to distinguish IDA from β-TT. In particular, patients with low Ret-He who don’t respond to iron therapy should be examined for β-TT.

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Differential Diagnosis of β-Thalassemia Trait from Iron Deficiency Anemia: Application of Bayesian Decision Tree

10.21203/rs.3.rs-157443/v1 ◽

2021 ◽

Author(s):

Mina Jahangiri ◽

Fakher Rahim ◽

Najmaldin Saki ◽

Amal Saki Malehi

Keyword(s):

Differential Diagnosis ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Area Under The Curve ◽

Microcytic Anemia ◽

Diagnostic Methods ◽

Deficiency Anemia ◽

Bayesian Decision ◽

Predictive Values ◽

Thalassemia Trait

Abstract Background: Several discriminating techniques have been proposed to discriminate between β‐thalassemia trait (βTT) and iron deficiency anemia (IDA) so far. These discrimination techniques are important clinically, but they are challenging and normally difficult; so if a patient with IDA is diagnosed as βTT, then it is deprived of iron therapy. This study is the first application of the Bayesian tree-based method for differential diagnosis of βTT from IDA. Method: In this study, 907 patients were enrolled with the ages over 18-year-old with microcytic anemia. Bayesian Logit Treed (BLTREED) has been used to discriminate βTT from IDA. Results: Mean corpuscular volume (MCV) was found as the main predictor in diagnostic discrimination. BLTREED model showed high sensitivity (96%), specificity (93%), accuracy (95%), Youden's index (89), as well as positive and negative predictive values in the differential diagnosis of βTT from IDA. Also, AUC revealed a more precise classification with an area under the curve value of 0.98.Conclusions: BLTREED model showed excellent diagnostic accuracy for differentiating βTT from IDA. In addition, understanding tree-based methods are easy and need not a statistical experience, so this advantage can help physicians in making the right clinical decision. Thus, we suggest the using of the BLTREED model as a powerful method in data mining techniques in order to develop sensitive and accurate diagnostic methods for for discriminating between these two anemia disorders.

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Red cell distribution width’s role in differentiating iron deficiency anemia from other hypochromic microcytic anemias

Zanco Journal of Medical Sciences ◽

10.15218/zjms.2021.028 ◽

2021 ◽

Vol 25 (3) ◽

pp. 625-632

Author(s):

Shno Hussein ◽

Abbas Rabaty

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Iron ◽

Microcytic Anemia ◽

Red Cell Distribution Width ◽

Deficiency Anemia ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Hypochromic Microcytic Anemia

Background and objective: The red cell distribution width is suggested to be a more sensitive indicator for microcytic hypochromic anemia. Therefore, this study aimed to determine the role of red cell distribution width in the diagnosis of iron deficiency anemia from other causes of hypochromic microcytic anemia. Methods: This cross-sectional study involved the children patients who attended Rapareen Teaching Hospital in Erbil city in 2019 and were diagnosed with hypochromic microcytic anemia. Results: The red cell distribution width was determined in a group of 70 children with iron deficiency anemia and 30 cases with a non-iron deficiency (other hypochromic microcytic anemias). Patients with a higher socio-demographic status were more likely to have iron deficiency anemia than those with low socio-demographic status; 82.61% vs. 76.60%, respectively. The patients with symptoms were more likely to be diagnosed with iron deficiency anemia (P = 0.024). The mean red cell distribution width value was 14.38%, 15.73%, and18.02% among mild, moderate, and severely anemic children (P <0.001). Increasing red blood cells (r=-0.271), hemoglobin (r=-0.454), serum iron (r=-0.601), and serum ferritin (r=-0.560) lead to decrease red cell distribution width. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of red cell distribution width in diagnosing iron deficiency anemia in children patients were 77.14%, 63.33%, 83.08%, 54.29%, and 73.0%, respectively. Conclusions: This study showed that red cell distribution width has good sensitivity and specificity in diagnosing iron deficiency anemia. Keywords: RDW; IDA; RBC indices; Microcytic anemia; Serum iron.

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