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 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 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.

Critical appraisal of discriminant formulas for distinguishing thalassemia from iron deficiency in patients with microcytic anemia

2017 ◽  
Vol 55 (10) ◽  
Author(s):  
Eloísa Urrechaga ◽  
Johannes J.M.L. Hoffmann
Keyword(s):  
Iron Deficiency ◽  
Patient Population ◽  
Diagnostic Performance ◽  
Roc Analysis ◽  
Critical Appraisal ◽  
Microcytic Anemia ◽  
Deficiency Anemia ◽  
Anemia Of Chronic Disease ◽  
Independent Verification ◽  
Thalassemia Trait

AbstractBackground:Many discriminant formulas have been reported for distinguishing thalassemia trait from iron deficiency in patients with microcytic anemia. Independent verification of several discriminant formulas is deficient or even lacking. Therefore, we have retrospectively investigated discriminant formulas in a large, well-characterized patient population.Methods:The investigational population consisted of 2664 patients with microcytic anemia: 1259 had iron deficiency, 1196 ‘pure’ thalassemia trait (877 β- and 319 α-thalassemia), 150 had thalassemia trait with concomitant iron deficiency or anemia of chronic disease, and 36 had other diseases. We investigated 25 discriminant formulas that only use hematologic parameters available on all analyzers; formulas with more advanced parameters were disregarded. The diagnostic performance was investigated using ROC analysis.Results:The three best performing formulas were the Jayabose (RDW index), Janel (11T), and Green and King formulas. The differences between them were not statistically significant (p>0.333), but each of them had significantly higher area under the ROC curve than any other formula. The Jayabose and Green and King formulas had the highest sensitivities: 0.917 both. The highest specificity, 0.925, was found for the Janel formula, which is a composite score of 11 other formulas. All investigated formulas performed significantly better in distinguishing β- than α-thalassemia from iron deficiency.Conclusions:In our patient population, the Jayabose RDW index, the Green and King formula and the Janel 11T score are superior to all other formulas examined for distinguishing between thalassemia trait and iron deficiency anemia. We confirmed that all formulas perform much better in β- than in α-thalassemia carriers and also that they incorrectly classify approximately 30% of thalassemia carriers with concomitant other anemia as not having thalassemia. The diagnostic performance of even the best formulas is not high enough for making a final thalassemia diagnosis, but in countries with limited resources, they can be helpful in identifying those patients who need further examinations for genetic anemia.

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.

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