Differential Diagnosis of Hypochromic Microcytic Anemia

1980 ◽  
Vol 1 (7) ◽  
pp. 196-222
Keyword(s):  
Iron Deficiency ◽  
Lead Poisoning ◽  
Microcytic Anemia ◽  
Beta Thalassemia ◽  
Age Group ◽  
Peak Incidence ◽  
Hypochromic Microcytic Anemia ◽  
Alpha Thalassemia ◽  
History Of ◽  
Thalassemia Trait

The only hypochromic microcytic anemias in young children are iron deficiency, lead poisoning, and thalassemia. Clinical features helpful in the diagnosis include the following. Iron deficiency: peak incidence from 1 to 2 years of age, diet deficient in iron, or ingestion of more than one quart of milk per day. Alpha-thalassemia trait: occurs in any age group and predominantly in Oriental, black, and Mediterranean races. Beta-thalassemia trait occurs in children more than 6 months of age and predominately in black and Mediterranean races. Lead poisoning: peak incidence from 6 months to 4 years of age and a history of pica. It occurs largely in urban children.

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 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 A Retrospective Assessment of Prevention and Treatment of Iron Deficiency Amongst Patients Requiring Peripartum Transfusion

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1264-1264
Author(s):  
Heather Vandermeulen ◽  
Yulia Lin ◽  
Anne McLeod ◽  
Jon Barrett ◽  
Michelle Sholzberg ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Red Blood Cell Transfusion ◽  
Beta Thalassemia ◽  
Alpha Thalassemia ◽  
Iron Deficient ◽  
Thalassemia Minor ◽  
Thalassemia Trait ◽  
In Pregnancy

Abstract Background: Iron deficiency is common and affects nearly 18% of pregnant women in the United States. This is attributable to both poor baseline stores in young women and the high iron requirements of pregnancy; a singleton pregnancy results in a net loss of 630 mg of iron. Both maternal and fetal outcomes are impacted by iron deficiency. There are higher rates of maternal postpartum depression, fetal growth restriction, prematurity and developmental delay when mothers are iron deficient in pregnancy. It is also important to avoid transfusions in women of child bearing age, due to the risks of alloimmunization and hemolytic disease of the newborn. Since iron deficiency is the most common cause of anemia in pregnant women, we sought to assess the prevalence of iron deficiency in women receiving peripartum red blood cell transfusions. Materials and Methods: This study is a retrospective quality review of all cases of peripartum transfusion at an academic centre caring for high risk pregnancies from January 2013 to July 2018. All women admitted to the Labor and Delivery ward who received a red blood cell transfusion were identified through electronic blood bank database. We also identified the next age-matched woman to deliver who was not transfused. Charts were reviewed for risk factors for iron deficiency, evidence of prior iron deficiency, iron supplementation during pregnancy and fetal outcomes such as birth weight, gestational age at delivery, NICU admission and fetal mortality. A detailed transfusion history was recorded for women who received peripartum transfusions, including peritransfusion hemoglobins and indication for transfusion. Results: To date, 120 cases of peripartum red blood cell transfusion have been reviewed. Of these, 19 patients were excluded due to chronic anemia unrelated to iron deficiency or pregnancy (e.g., chronic renal failure). Age matched controls have been identified and are pending review. Preliminary data suggests that the majority of red cell transfusions given in the peripartum period are to women experiencing antepartum (26%) and/or postpartum (63%) hemorrhage. Thirty seven percent of women who were transfused had documented anemia in pregnancy and 51% of women were iron deficient in pregnancy (ferritin <30 ng/mL). Twenty one percent of women in the transfused group were noted to have pre-existing iron deficiency before conceiving. In the transfused cohort, six patients were identified as having alpha thalassemia trait (3 cases) or beta thalassemia minor (3 cases). Discussion: We present the preliminary results of a retrospective review of cases of peripartum red cell transfusion at an academic centre. Although a significant portion of transfusions were unavoidable and attributable to hemorrhage, it may be possible to decrease the number of units these women require. Over half of women who were transfused had documented iron deficiency in pregnancy. This raises the question of how many units of red blood cells could have been saved by appropriately treating these patients' iron deficiency. It is also clear in the literature that iron deficiency is associated with multiple poor fetal and maternal outcomes; we have identified an opportunity to improve the care of these women and their babies. We plan to feed this information back to the Obstetrical caregivers at our centre and to help educate providers about the recognition and treatment of iron deficiency in pregnancy. The high rate of transfusion amongst patients with alpha thalassemia trait and beta thalassemia minor warrants further investigation, but may highlight a knowledge gap around transfusion triggers for these patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Soluble transferrin receptor and immature reticulocytes are not useful for distinguishing iron-deficiency anemia from heterozygous beta-thalassemia

2003 ◽  
Vol 121 (2) ◽  
pp. 90-91 ◽  
Author(s):  
Gisélia Aparecida Freire Maia de Lima ◽  
Helena Zerlotti Wolf Grotto
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Transferrin Receptor ◽  
Microcytic Anemia ◽  
Deficiency Anemia ◽  
Beta Thalassemia ◽  
Soluble Transferrin Receptor ◽  
Hypochromic Microcytic Anemia ◽  
Significant Difference ◽  
High Fluorescence

Iron deficiency and heterozygous beta-thalassemia are important causes of hypochromic-microcytic anemia. Two laboratory parameters are suggested for the differentiation of such anemia. High-fluorescence reticulocyte counts and soluble transferrin receptor levels were determined in iron-deficiency anemia patients (n = 49) and heterozygous beta-thalassemia patients (n = 43). There was no significant difference in high-fluorescence reticulocyte and soluble transferrin receptor values between the two groups, but a correlation was observed between high-fluorescence reticulocytes and soluble transferrin receptors in iron-deficiency anemia, probably due to increased receptor synthesis as a response to decreased iron content in erythrocytes.

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.

HYPOCHROMIC MICROCYTIC ANEMIA OF INFANCY: IRON DEPLETION AS A FACTOR

PEDIATRICS ◽  
1956 ◽  
Vol 18 (6) ◽  
pp. 959-978
Author(s):  
Hugh W. Josephs
Keyword(s):  
Iron Deficiency ◽  
Severe Infection ◽  
Microcytic Anemia ◽  
Severe Anemia ◽  
Iron Depletion ◽  
Hypochromic Microcytic Anemia ◽  
Premature Babies ◽  
Number Of Factors ◽  
The Difference ◽  
Insight Into

In this work the author has attempted to gain insight into the significance of iron depletion by the use of 4 simple calculations, justification for which is found in recent articles. These are: (a) iron with which the infant is born; (b) iron retained from the food; (c) iron being used by the tissues and therefore unavailable for hemoglobin, and (d) iron combined with the total mass of hemoglobin. With these 4 figures it is possible to estimate the iron still potentially available for use (the "reserves" or "stones"). When the difference between a + b and c + d has reached about zero, depletion is considered to exist. The following characteristics of depletion may be emphasized: Depletion is the result of gain in weight and maximum possible usage of iron. It is therefore a normal result of growth and need not be associated with anemia. As soon as depletion has occurred, the organism is thereafter dependent on current absorption of iron. This is ordinarily sufficient, even with a diet of milk alone, to maintain an adequate concentration of hemoglobin after about 8 to 10 months of age. Severe anemia due to depletion alone is practically confined to premature babies whose relative gain in weight is rapid. Severe anemia in other than premature babies is the result of a number of factors by which iron becomes unavailable or is actually diverted from hemoglobin to storage. Response to iron medication is considerably better in infants with depletion than in those in whom some factor is present that interferes with iron utilization, and which is not connected by the mere giving of iron. The dependence on current absorption, whether the result of depletion or non-availability, introduces a certain precariousness which is apparently characteristic of this time of life. The organism gets along from day to day if nothing happens, but may not be able to meet an emergency, whether this appears as a rapid gain in weight, or a necessity to repair damage done by severe infection. If we consider iron deficiency as the cause of anemia, we can think of deficiency as due to a number of factors of which depletion is only one. The development and characteristics of depletion have been considered in this paper; other factors in iron deficiency will be considered in subsequent papers.

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.

Diagnosis of Rare Antibody Anti-Ata in Pregnancy: A Case Report

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S152-S153
Author(s):  
Mehran Taherian ◽  
Zhonghua Liu ◽  
Melissa Petras
Keyword(s):  
Term Infant ◽  
Beta Thalassemia ◽  
Healthy Children ◽  
Hemolytic Disease ◽  
High Prevalence ◽  
High Incidence ◽  
History Of ◽  
Thalassemia Trait ◽  
Ectopic Pregnancies ◽  
Compatible Blood

Abstract Background Anti-Augustine antigen (Ata) is a high-prevalence RBC antigen, and anti-Ata is an extremely rare RBC alloantibody. Anti-Ata is usually produced by an Ata (–) individual after alloimmunization by transfusion or during a pregnancy and is associated with immediate or delayed hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. We report the detection of a unique antibody to an antigen of high incidence, the anti-Ata. Case Presentation The patient was a 26-year-old African American pregnant female G7P2042 with a medical history of beta-thalassemia trait, presented at her second trimester for evaluation of abdominal cramping. The patient has had two prior ectopic pregnancies, managed surgically, and two healthy children delivered vaginally with no obstetric or congenital complications. She was treated for a pulmonary embolism a few months before while she was on OCPs. She had no prior transfusions. She also had anemia (RBC 4.1 × 1012/L, Hgb 9.7 g/dL, Hct 29.6%, MCV 72.2 fL). The patient’s blood sample was sent for type and screen, and it came positive for anti-Ata antibody. This test was performed at Memorial Blood Centers (a reference lab) and Kaleida Health Laboratories. The phenotype of our patient was c+ E+ e+ k+ Kpb+ Jsb+ Jka+ M+ N+ s+ U+ Lub+. The baby was followed with serial fetal middle cerebral arterial (MCA) Doppler assessment, without evidence of fetal anemia. The term infant was delivered by cesarean section without complications. Currently, both mother and baby are doing well. Conclusion Although anti-Ata is unlikely to cause hemolytic disease of the newborn, it is important to ensure that compatible blood is available should the mother require transfusion postdelivery.

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