Red Blood Cell Distribution Width in Pediatric Microcytic Anemias

The RBC distribution width has been reported to be of value in the discrimination of iron deficiency anemia from other microcytic anemias, but studies in pediatric populations are lacking. A population of 734 normal children was studied to establish age-appropriate normal values for RBC distribution width. The RBC distribution width of 47 patients with microcytic anemia was then evaluated. RBC distribution width was elevated in 19 of 22 patients with iron deficiency but was also increased in six of 14 patients with thalassemia trait and two of 11 patients with anemia secondary to inflammatory disease. The resulting discrimination was better than that obtained by using Mentzer's index or the discriminant function in the patients studied. The RBC distribution width, albeit a less then perfect tool, can be of value in evaluating pediatric patients with microcytic anemia.

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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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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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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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Inherited microcytic anemias

Hematology ◽

10.1182/hematology.2020000158 ◽

2020 ◽

Vol 2020 (1) ◽

pp. 465-470

Author(s):

Maria Domenica Cappellini ◽

Roberta Russo ◽

Immacolata Andolfo ◽

Achille Iolascon

Keyword(s):

Iron Deficiency ◽

Blood Cell ◽

Iron Metabolism ◽

Red Blood Cell ◽

Iron Status ◽

Transferrin Saturation ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Mean Corpuscular Hemoglobin ◽

Distribution Width

Abstract Inherited microcytic anemias can be broadly classified into 3 subgroups: (1) defects in globin chains (hemoglobinopathies or thalassemias), (2) defects in heme synthesis, and (3) defects in iron availability or iron acquisition by the erythroid precursors. These conditions are characterized by a decreased availability of hemoglobin (Hb) components (globins, iron, and heme) that in turn causes a reduced Hb content in red cell precursors with subsequent delayed erythroid differentiation. Iron metabolism alterations remain central to the diagnosis of microcytic anemia, and, in general, the iron status has to be evaluated in cases of microcytosis. Besides the very common microcytic anemia due to acquired iron deficiency, a range of hereditary abnormalities that result in actual or functional iron deficiency are now being recognized. Atransferrinemia, DMT1 deficiency, ferroportin disease, and iron-refractory iron deficiency anemia are hereditary disorders due to iron metabolism abnormalities, some of which are associated with iron overload. Because causes of microcytosis other than iron deficiency should be considered, it is important to evaluate several other red blood cell and iron parameters in patients with a reduced mean corpuscular volume (MCV), including mean corpuscular hemoglobin, red blood cell distribution width, reticulocyte hemoglobin content, serum iron and serum ferritin levels, total iron-binding capacity, transferrin saturation, hemoglobin electrophoresis, and sometimes reticulocyte count. From the epidemiological perspective, hemoglobinopathies/thalassemias are the most common forms of hereditary microcytic anemia, ranging from inconsequential changes in MCV to severe anemia syndromes.

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Frequency and types of hemoglobinopathies in children with microcytic anemia

Journal of the Pakistan Medical Association ◽

10.47391/jpma.589 ◽

2020 ◽

pp. 1-10

Author(s):

Sabeen Khan ◽

Sahira Aaraj ◽

Syeda Namayah Fatima Hussain

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anaemia ◽

Health Centre ◽

Thalassemia Major ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Antenatal Screening ◽

Microcytic Anaemia ◽

Deficiency Anaemia ◽

Thalassemia Trait

Abstract Objective: To study the frequency and types of haemoglobinopathies in children with microcytic anaemia. Method: The prospective study was conducted at the Paediatric Out-patient Department of Shifa Falahi Community Health Centre, Islamabad, Pakistan, from July to December, 2018, and comprised patients aged from 3 months to 14 years who had haemoglobin <10mg/dl and mean corpuscular volume <70fL. Serum ferritin and haemoglobin electrophoresis were done to check for iron deficiency anemia and haemoglobinopathies. Data was analysed using SPSS 23. Results: Of 175 subjects, 33(18.9%) had haemoglobinopathies and 142(81.1%) had iron deficiency anaemia. Thalassemia trait 18(10.3%) was the leading cause amongst haemoglobinopathies, followed by thalassemia major 8(4.6 %) and intermedia 5(2.9%). There were 2(1.1%) patients with haemoglobin D. Conclusion: The prevalence of hemoglobinopathies was high. Identification of haemoglobinopathies is important for proper treatment, antenatal screening and future genetic counselling. Key Words: Haemoglobinopathy, Iron deficiency anaemia, Microcytic, MCV, IDA.

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Red cell cytogram in CELL-DYN® Sapphire: a ready-to-use function for recognizing thalassemia trait

Thalassemia Reports ◽

10.4081/thal.2016.5260 ◽

2016 ◽

Vol 6 (1) ◽

Author(s):

Eloísa Urrechaga ◽

Ohiane Boveda ◽

Johannes J.M.L. Hoffmann

Keyword(s):

Iron Deficiency ◽

Visual Inspection ◽

Numerical Data ◽

Hemoglobin Concentration ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Red Cell ◽

Optical Analysis ◽

Presumptive Diagnosis ◽

Thalassemia Trait

Single-cell optical analysis of red blood cells provides information on the cellular hemoglobin concentration and volume of red cells. We evaluated the reliability of the typical profiles of the cytogram hemoglobin concentration/ volume (Mie Map), produced by the CELL-DYN® Sapphire analyzer (Abbott Diagnostics, Santa Clara, CA, USA) in the discrimination of iron deficiency anemia (IDA) and thalassemia trait. A total of 380 patients with microcytic anemia were studied: 220 with IDA, 101 β-thalassemia trait, 30 β-thalassemia trait with concomitant iron deficiency, 29 α-thalassemia trait. Three professionals reviewed the Mie maps, with no information regarding the disease of the patient. The observers made a presumptive diagnosis (genetic or acquired anemia) and the percentages of correct classifications were recorded. IDA showed broad shaped shift of the cytogram while carriers presented narrow clustering in the lower microcytic area: 100 % IDA were correctly classified and 96-82% of carriers were recognized. Visual inspection of the Mie map reveals different profiles in IDA and thalassemia trait; those patterns are in concordance with the numerical data Mie map helps in the evaluation of large amounts of data. 红细胞单细胞光学分析提供了关于细胞血红蛋白浓度及红细胞体积的信息。我们评价了典型的细胞图血红蛋白浓度/体积分布（Mie Map）在缺铁性贫血（IDA）和地中海贫血特征的识别方面的可靠性，分布曲线由CELL-DYN® Sapphire分析仪（Abbott Diagnostics, Santa Clara, CA, USA）生成。一共对380例小细胞性贫血进行了研究：220例患有IDA，101例β有地中海贫血特征，30例β有地中海贫血特征合并缺铁性，29 α例地中海贫血特征。由三名专业人员在没有任何患者病情信息的情况下进行Mie map读图。读图者作出初步诊断（遗传性或获得性贫血），记录正确分类的百分比。 IDA表现出细胞图较宽发散形状的偏移，而基因携带者在更低的小细胞区域呈现较窄的聚集：100%的IDA被正确分类，96-82%的基因携带者得到确认。 Mie map的目测检查揭示了IDA和地中海贫血特征方面不同的分布；这些模式与数值数据相一致。Mie map有助于大量数据的评估。

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

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2016-0856 ◽

2017 ◽

Vol 55 (10) ◽

Cited By ~ 13

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.

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UTILITY OF BLOOD INDICES AND PARAMETERS FOR DIFFERENTIATING IRON DEFICIENCY ANAEMIA AND β-THALASSEMIA TRAIT BY CALCULATING VARIOUS DISCRIMINANT FUNCTIONS

10.36106/paripex/3911810 ◽

2021 ◽

pp. 144-146

Author(s):

Mansi Davda ◽

Sachin Patel ◽

Kinalee Chothani ◽

Jigna Upadhyay

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anaemia ◽

Deficiency Anemia ◽

Red Cell ◽

Discriminant Functions ◽

Distribution Width ◽

Deficiency Anaemia ◽

Blood Indices ◽

Thalassemia Trait ◽

Rbc Count

The most commonly encountered disorders with microcytic anemia are iron deficiency anemia (IDA) and β-thalassemia trait (BTT).It is important to distinguish between IDA and BTT to avoid unnecessary iron therapy and the development of hemosiderosis.Various parameters obtained on automated haematology analyser by calculating discriminant functions have been helpful to differentiate iron deficiency anemia and β-thalassemia trait. Materials and Methods: This study was carried out in the pathology department of Gujarat Adani Institute Of Medical Science.We had studied 100 cases of differentiating Iron deficiency anaemia and β-Thalassaemia trait from patient's case records and laboratory reports irrespective of age and sex over a period of one year (January 2020 to December 2020).Tests for serum iron and ferritin were carried out in individuals showing low hemoglobin (Hb). All the selected subjects' samples were subjected to blood morphology, comparison of mean cell volume (MCV), RBC count, red cell distribution width (RDW), Red cell distribution width Index (RDWI),Srivastav Index(SI),Green and king Index (GI) and Mentzer's Index(MI). Results: Out of 100 cases seventy five were diagnosed having iron deficiency anaemia, whereas twenty five were having βthalassemia trait. The RBC count was higher and MCV was much lower in β-thalassemia trait as compared to iron deficiency anaemia.Both groups were subjected to RDW,RDWI,SI,MI and GI. Conclusion:Among various discriminant function calculated from different haematological parameters and blood indices,Mentzer index and Srivasta index are more sensitive and specific for differentiating iron deficiency anaemia and β-thalassemia trait.

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

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-019-0929-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 6

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.

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Multivariable Discriminant Analysis for the Differential Diagnosis of Microcytic Anemia

Anemia ◽

10.1155/2013/457834 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Eloísa Urrechaga ◽

Urko Aguirre ◽

Silvia Izquierdo

Keyword(s):

Differential Diagnosis ◽

Discriminant Analysis ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Multiple Discriminant Analysis ◽

Mean Cell Volume ◽

Distribution Width ◽

Linear Discriminant

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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