Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia: a meta-analysis

2015 ◽  
Vol 53 (12) ◽  
Author(s):  
Johannes J.M.L. Hoffmann ◽  
Eloísa Urrechaga ◽  
Urko Aguirre
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Meta Analysis ◽  
Diagnostic Odds Ratio ◽  
Microcytic Anemia ◽  
Deficiency Anemia ◽  
Extensive Literature ◽  
Discriminant Index ◽  
Extensive Literature Search ◽  
Thalassemia Trait

AbstractMore 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.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.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.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.

scholarly journals 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

1996 ◽  
Vol 114 (5) ◽  
pp. 1265-1269 ◽  
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.

scholarly journals ThalPred: a web-based prediction tool for discriminating thalassemia trait and iron deficiency anemia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
V. Laengsri ◽  
W. Shoombuatong ◽  
W. Adirojananon ◽  
C. Nantasenamat ◽  
V. Prachayasittikul ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Nearest Neighbor ◽  
Laboratory Data ◽  
Model Performance ◽  
Microcytic Anemia ◽  
Deficiency Anemia ◽  
Support Vector ◽  
Web Based ◽  
Thalassemia Trait

Abstract Background The hypochromic microcytic anemia (HMA) commonly found in Thailand are iron deficiency anemia (IDA) and thalassemia trait (TT). Accurate discrimination between IDA and TT is an important issue and better methods are urgently needed. Although considerable RBC formulas and indices with various optimal cut-off values have been developed, distinguishing between IDA and TT is still a challenging problem due to the diversity of various anemic populations. To address this problem, it is desirable to develop an improved and automated prediction model for discriminating IDA from TT. Methods We retrospectively collected laboratory data of HMA found in Thai adults. Five machine learnings, including k-nearest neighbor (k-NN), decision tree, random forest (RF), artificial neural network (ANN) and support vector machine (SVM), were applied to construct a discriminant model. Performance was assessed and compared with thirteen existing discriminant formulas and indices. Results The data of 186 patients (146 patients with TT and 40 with IDA) were enrolled. The interpretable rules derived from the RF model were proposed to demonstrate the combination of RBC indices for discriminating IDA from TT. A web-based tool ‘ThalPred’ was implemented using an SVM model based on seven RBC parameters. ThalPred achieved prediction results with an external accuracy, MCC and AUC of 95.59, 0.87 and 0.98, respectively. Conclusion ThalPred and an interpretable rule were provided for distinguishing IDA from TT. For the convenience of health care team experimental scientists, a web-based tool has been established at http://codes.bio/thalpred/ by which users can easily get their desired screening test result without the need to go through the underlying mathematical and computational details.

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

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.

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

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.

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

Anemia ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
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.

scholarly journals Diagnostic performance of hematological discrimination indices to discriminate between βeta thalassemia trait and iron deficiency anemia and using cluster analysis: Introducing two new indices tested in Iranian population

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Mina Jahangiri ◽  
Fakher Rahim ◽  
Amal Saki Malehi
Keyword(s):  
Cluster Analysis ◽  
Iron Deficiency ◽  
Diagnostic Accuracy ◽  
Iron Deficiency Anemia ◽  
Diagnostic Performance ◽  
Microcytic Anemia ◽  
Deficiency Anemia ◽  
Thalassemia Trait ◽  
Accuracy Measures ◽  
Good Diagnostic Accuracy

AbstractAlthough the discrimination between β-thalassemia trait (βTT) and Iron deficiency anemia (IDA) is important clinically, but it is challenging and normally difficult; so if a patient with IDA is diagnosed as βTT, then it is deprived of iron therapy. This study purpose was to evaluate the 26 different discriminating indices diagnostic function in patients with microcytic anemia by using accuracy measures, and also recommending two distinct new discriminating indices as well. In this study, 907 patients were enrolled with the ages over 18-year-old with either βTT or IDA. Twenty-six discrimination indices diagnostic performance presented in earlier studies, and two new indices were introduced in this study (CRUISE index and index26) in order to evaluate the differential between βTT and IDA by using accuracy measures. 537 (59%) patients with βTT (299 (56%) women, and 238 (44%) men), and also 370 (41%) patients with IDA (293 (79%) women, and 77 (21%) men) were participated in this study for evaluating the 28 discrimination indices diagnostic performance. Two new introduced indices (CRUISE index and index26) have better performance than some discrimination indices. Indices with the amount of AUC higher than 0.8 had very appropriate diagnostic accuracy in discrimination between βTT and IDA, and also CRUISE index has good diagnostic accuracy, too. The present study was also the first cluster analysis application in order to identify the homogeneous subgroups of different indices with similar diagnostic function. In addition, new indices that offered in this study have presented a relatively closed diagnostic performance by using cluster analysis for the different indices described in earlier studies. Thus, we suggest the using of cluster analysis in order to determine differential indices with similar diagnostic performances.

scholarly journals Application of Bayesian Decision Tree in Hematology Research: Differential Diagnosis of β-Thalassemia Trait from Iron Deficiency Anemia

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Mina Jahangiri ◽  
Fakher Rahim ◽  
Najmaldin Saki ◽  
Amal Saki Malehi
Keyword(s):  
Differential Diagnosis ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Hematological Parameters ◽  
False Positive Rate ◽  
Deficiency Anemia ◽  
Beta Thalassemia ◽  
Bayesian Tree ◽  
Thalassemia Trait ◽  
Cart Algorithm

Objective. Several discriminating techniques have been proposed to discriminate between β-thalassemia trait (βTT) and iron deficiency anemia (IDA). These discrimination techniques are essential clinically, but they are challenging and typically difficult. This study is the first application of the Bayesian tree-based method for differential diagnosis of βTT from IDA. Method. This cross-sectional study included 907 patients with ages over 18 years old and a mean (±SD) age of 25 ± 16.1 with either βTT or IDA. Hematological parameters were measured using a Sysmex KX-21 automated hematology analyzer. Bayesian Logit Treed (BLTREED) and Classification and Regression Trees (CART) were implemented to discriminate βTT from IDA based on the hematological parameters. Results. This study proposes an automatic detection model of beta-thalassemia carriers based on a Bayesian tree-based method. The BLTREED model and CART showed that mean corpuscular volume (MCV) was the main predictor in diagnostic discrimination. According to the test dataset, CART indicated higher sensitivity and negative predictive value than BLTREED for differential diagnosis of βTT from IDA. However, the CART algorithm had a high false-positive rate. Overall, the BLTREED model showed better performance concerning the area under the curve (AUC). Conclusions. The BLTREED model showed excellent diagnostic accuracy for differentiating βTT from IDA. In addition, understanding tree-based methods are easy and do not need statistical experience. Thus, it can help physicians in making the right clinical decision. So, the proposed model could support medical decisions in the differential diagnosis of βTT from IDA to avoid much more expensive, time-consuming laboratory tests, especially in countries with limited recourses or poor health services.

scholarly journals Kandidias Oral pada Penderita Anemia Defisiensi Besi (Fe) dan Penetalaksanaannya

2012 ◽  
Vol 19 (1) ◽  
pp. 77
Author(s):  
Sri Budiarti Wongsohardjono
Keyword(s):  
Body Weight ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Oral Candidiasis ◽  
Dorsal Surface ◽  
Body Weight Loss ◽  
Microcytic Anemia ◽  
The Body ◽  
Deficiency Anemia ◽  
Normal Limits

Background: Iron deficiency anemia is a microcytic anemia caused by chronic blood loss dueto such problems as excessive menstrual flow, gastrointestinal bleeding, gasterektomi or malabsorption that reduces the absorption of Fe. Predisposing factors that lead to the disruption of the ecology of oral candidiasis or oral microbiological changes can be due to malnutrition (iron deficiency, folic acid, vitamin B12) and the very old age. Objective: To report a case of iron deficiency anemia with oral candidiasis and its management. Case Report: A 69-year man in the reference by peer demonstrated swollen gums, mouth pain and difficulty in swallowing. A moth ago he was hospitalized and boarded for a week but no change, his body weight loss was 25kg. paleconjunctiva and face, droliing, looked weak. The body temperature was 370 C; the BP measurement was: 125/80mmHg; with body weight was 50kg; right and left submandibular  lymph nodes become enlarging and soreness palpatiom. Symmetrical face. Right and left lip corners are angular kheilitis, cheek mucosa, palate hyperemia, gingival stipling was disappeared, hyperemia, dorsal surface smooth tongue, hyperemia, depapilasi, OHI: bad; thick saliva, hypersalivation. A lot of dental caries and the remaining roots. Management: Examination of the saliva with KOH solution looked a hyphe. Routine blood tests and profile of fe all within normal limits except RBC was 3,37.106 / uL; HGB: 11.0 g / dl; HCT: 32.2%, Fe 29.00 u g / dl (below normal). Treatment with 3% perhidrol mouthwash, Nyistatin solution 3 x daily. Zegase tablet 2x daily. Paracetamol tablets if necessary. Conclusion sixteen days later the patient recovered.

scholarly journals Mutation of the gastric hydrogen-potassium ATPase alpha subunit causes iron-deficiency anemia in mice

Blood ◽  
2011 ◽  
Vol 118 (24) ◽  
pp. 6418-6425 ◽  
Author(s):  
Lara Krieg ◽  
Oren Milstein ◽  
Philippe Krebs ◽  
Yu Xia ◽  
Bruce Beutler ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Absorption ◽  
Osmotic Fragility ◽  
Microcytic Anemia ◽  
Deficiency Anemia ◽  
Α Subunit ◽  
Hypochromic Microcytic Anemia ◽  
Gastric Proton Pump ◽  
Potassium Atpase

Abstract Iron is an essential component of heme and hemoglobin, and therefore restriction of iron availability directly limits erythropoiesis. In the present study, we report a defect in iron absorption that results in iron-deficiency anemia, as revealed by an N-ethyl-N-nitrosourea–induced mouse phenotype called sublytic. Homozygous sublytic mice develop hypochromic microcytic anemia with reduced osmotic fragility of RBCs. The sublytic phenotype stems from impaired gastrointestinal iron absorption caused by a point mutation of the gastric hydrogen-potassium ATPase α subunit encoded by Atp4a, which results in achlorhydria. The anemia of sublytic homozygotes can be corrected by feeding with a high-iron diet or by parenteral injection of iron dextran; rescue can also be achieved by providing acidified drinking water to sublytic homozygotes. These findings establish the necessity of the gastric proton pump for iron absorption and effective erythropoiesis.

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