Sensitivity, specificity and efficiency of different discriminative indexes in differentiation of thalassemia trait from iron deficiency anemia

A complete blood count (CBC), separation of haemoglobin molecules by electrophoresis at pH 8.4 followed by scanning densitometry and ethnic background, all together, are absolutely necessary in the diagnosis of β- thalassemia trait. The aim of this study was to assess the specificity, sensitivity and efficiency of six different discriminative indexes in differentiation of thalassemia trait from iron deficiency anemia and if they alone may replace the haemoglobin electrophoresis. In this study there were analyzed 638 adult and child blood samples by haemoglobin electrophoresis at pH 8.4 on an agarose gel. For all these samples a CBC was initially performed on a fully automated system. 435 patients diagnosed with β- thalassemia minor were further analyzed for thalassemia mutations. An individual evaluation for six discriminative indexes that included the CBC parameters was performed to differentiate thalassemia trait from iron deficiency anemia. The evaluation was performed on 542 samples with a clear diagnosis which included 107 samples with HbA2 within the reference range and 435 samples with the diagnosis of β-thalassemia minor. The Shine and Lal index showed good specificity, sensitivity and efficiency. For 96 patients we could not evaluate these six discriminative indexes, the diagnosis being inconclusive. In conclusion CBC and the discriminative indexes cannot replace the haemoglobin electrophoresis in diagnosing βthalassemia trait.

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Screening to Determine Prevalence of β-Thalassemia and Iron Deficiency Anemia Among Medical Students

BioSight ◽

10.46568/bios.v1i2.9 ◽

2020 ◽

Vol 1 (2) ◽

pp. 24-30

Author(s):

Saddam Kalwar ◽

Akbar Agha ◽

Aribah Naz ◽

Afsheen Arif

Keyword(s):

High Performance Liquid Chromatography ◽

Liquid Chromatography ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

High Performance ◽

Blood Count ◽

Complete Blood Count ◽

Deficiency Anemia ◽

Medical College ◽

Thalassemia Trait

According to the Thalassemia Federation of Pakistan, the mostly inherited disorder in Pakistan is β-thalassemia, which is characterized by a deficient, abnormal, or lack of β-globin chain synthesis and has a prevalence of 6%. The only method of controlling and preventing β-thalassemia is to increase awareness among students. This was an observational study using a random sampling technique. The Dow-Thalassemia awareness program recruited 915 medical students from the Dow Medical College (DMC) and Sindh Medical College (SMC) to voluntarily donate blood samples, which were analyzed by the naked eye single tube red cell osmotic fragility test (NESTROFT) and complete blood count and results were confirmed by high-performance liquid chromatography and analyzed using the NESTROFT. The samples were collected in 2012-2013. A total of 915 samples, out of these 390 samples, 390/915 (42.6%) samples were positive and complete blood count found 282 (72.3%) were positive for iron deficiency anemia. The remaining 108/390 (27.6%) were confirmed by high-performance liquid chromatography. Only 2.4 % subjects were positive for the β-thalassemia trait. Of 915 students, 57.4% of students were healthy, 39.2% had iron deficiency anemia, and 2.4% were carriers of the β-thalassemia trait. The overall prevalence of β-thalassemia was 38/915 (4.1%), which was lower than observed in previous studies. This study also demonstrated the NESTROFT can be used as a primary method of screening out healthy individuals, where approximately 50% require further screening for β-thalassemia

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Evaluation of Twenty Four Discriminant Indices for Differentiating Beta-Thalassemia Trait from Iron Deficiency Anemia in Egyptians

Iranian Journal of Pediatric Hematology & Oncology ◽

10.18502/ijpho.v9i3.1163 ◽

2019 ◽

Author(s):

Shaimaa Abdelmalik Pessar

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Complete Blood Count ◽

Deficiency Anemia ◽

Beta Thalassemia ◽

True Negative ◽

Cross Sectional ◽

Diagnostic Reliability ◽

Distribution Width ◽

Thalassemia Trait

Background: Many Red Blood Cell (RBC) indices have been developed based on mathematical formulae to discriminate beta-thalassemia trait (βTT) from iron deficiency anemia (IDA). The latter two conditions represent the most common causes of microcytic hypochromic anemia in Egypt. This study aimed To evaluate the diagnostic reliability of 24 published discriminant indices for differentiating βTT from IDA in Egyptians. Materials and Methods: A cross sectional study included a total of 166 subjects (108 IDA & 58 βTT) aged 1-18 years were recruited from Hematology laboratory of Pediatric Hospital, Ain Shams University, Cairo, Egypt. A full diagnostic algorithm was performed using complete blood count, hemoglobin electrophoresis by High Performance Liquid Chromatography (HPLC), iron profile and PCR detection of 22 mutations common for βTT. Twenty-four formulas were applied and their performance characteristics were calculated for each index. Results: The highest accuracy (True positive + True negative/ All cases) & Youden's Index (Sensitivity+Specificity-100) were for Red Cell Distribution Width (RDWI) and Hameed index closely followed by Keikhaei index while the least performance was for RDW-SD, RDW-CV and Shine & Lal indices. Conclusion The superiority of an index over another in distinguishing βTT from IDA allowed only partially better selection of cases warranting further confirmatory molecular studies. None of the studied formulae provided a surrogate test for Hb electrophoresis as mass screening.

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Difference of Het Re Level In Thalassemia β Minor And Iron Deficiency Anemia

STRADA JURNAL ILMIAH KESEHATAN ◽

10.30994/sjik.v9i2.515 ◽

2020 ◽

Vol 9 (2) ◽

pp. 1635-1641

Author(s):

Yustisia Amalia

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Complete Blood Count ◽

Deficiency Anemia ◽

Beta Thalassemia ◽

Inclusion Criteria ◽

Consecutive Sampling ◽

Thalassemia Minor ◽

Significant Difference ◽

The University

The population was students who were admitted to the University of Dr. Soetomo who came for complete blood count examination. The subjects were students with MCV <80 fl, MCH <27 pq. Subjects who met the inclusion criteria then continued with the calculation of the Mentzer Index and RDW Index, ferritin serum examination using the ECLIA method, hemoglobin electrophoresis examination with micro capillary electrophoresis. By consecutive sampling, 42 samples were obtained, of which 21 subjects diagnosed with iron deficiency anemia and 21 subjects diagnosed with beta thalassemia minor were examined for their Ret-He levels using the flowsitometric method which were then analyzed statistically.From the results of the study concluded that there was a significant difference between the levels of Ret-He in patients with iron deficiency anemia with thalassemia beta minor patients with a cut-off value of 27.30pg

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POS0567 HEPCIDIN IS POTENTIAL BIOMARKER TO DISTINGUISH BETWEEN IRON DEFICIENCY ANEMIA AND ANEMIA OF INFLAMMATION IN RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3303 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 518.2-518

Author(s):

E. Galushko ◽

A. Semashko ◽

A. Gordeev ◽

A. Lila

Keyword(s):

Rheumatoid Arthritis ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Complete Blood Count ◽

Deficiency Anemia ◽

Reactive Protein ◽

Potential Biomarker ◽

Serum Hepcidin ◽

Proper Diagnosis ◽

Anemia Of Inflammation

Background:Anemia of inflammation (AI) and iron deficiency anemia (IDA) are the two most prevalent forms of anemia in patients with rheumatoid arthritis (RA). Diagnosis becomes challenging if AI is associated with true ID (AI/ID), as there is still a lack of a gold standard for differentiation between AI and AI/ID. However, as therapies to overcome anemia differ, proper diagnosis and understanding of underlying pathophysiological regulations are necessary.Objectives:The aim of the study was to evaluate the clinical efficiency of hepcidin, a key regulator of iron metabolism, in the diagnosis of IDA, as well as the differential diagnosis of AI/ID and AI in patients with RA.Methods:The study was undertaken 96 patients with RA, 67 of them were diagnosed anemia according to WHO criteria (104,3±21,4 g/l). Anemic patients and anemia-free patients with RA (n=29) were comparable (p>0.05) in age (44.4±14.8 and 49.8±9.3 years), disease duration (73.5±65.4 and 59.8±48.3 months) and DAS28 (6.3±1.6 and 5.9±1.9). All cases were subjected to following tests: complete blood count with peripheral smear, serum C-reactive protein, serum interleukin-6, iron studies, serum soluble transferrin receptor (sTfR), and serum hepcidin. Patients with RA and anemia were divided two groups: 25 patients with IDA and 42 - with AI. The AI cases were subdivided into pure AI and AI with coexistent ID (n=15).Results:The mean serum hepcidin concentration was significantly increased in pure AI patients (123.85±25.8 ng/mL) as compared to those in IDA patients (63.9±22.8 ng/mL, P < 0.05) and anemia-free patients with RA (88.1±39.09 ng/mL). Also, compared to pure AI patients [normal sTfR levels (<3 µg/mL)], the serum hepcidin concentration was reduced significantly in AI patients with ID [high sTfR levels (≥3 µg/mL)] with a mean of 79.0±23.97 ng/mL.Conclusion:Hepcidin measurement can provide a useful tool for differentiating AI from IDA and also help to identify an iron deficiency in AI patients. This might aid in the appropriate selection of therapy for these patients.Disclosure of Interests:None declared

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

Computational and Mathematical Methods in Medicine ◽

10.1155/2021/6401105 ◽

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.

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Pseudothrombocytosis due to Microerythrocytosis: A Case of Beta Thalassemia Minor Complicated with Iron Deficiency Anemia

Acta Haematologica ◽

10.1159/000346434 ◽

2013 ◽

Vol 130 (2) ◽

pp. 61-63 ◽

Cited By ~ 3

Author(s):

Sema Akinci ◽

Tuba Hacibekiroglu ◽

Abdulkadir Basturk ◽

Sule Mine Bakanay ◽

Tekin Guney ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Deficiency Anemia ◽

Beta Thalassemia ◽

Thalassemia Minor

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Using Reticulocyte Hemoglobin Equivalent (RET- He) in Diagnosis of Iron Deficiency Anemia

QJM ◽

10.1093/qjmed/hcaa044.005 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

R A R Ahmed ◽

M H A Fayek ◽

D A D Salem

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Ferritin ◽

Complete Blood Count ◽

Area Under The Curve ◽

Deficiency Anemia ◽

Control Group ◽

Chronic Disorder ◽

Evaluation Of Parameters

Abstract Background Anemia is a significant worldwide health problem. Approximately one third of the world's population suffers from anemia, half of which is due to iron deficiency (ID). Evaluation of parameters relating to serum ferritin and iron is critically important in the diagnosis of iron deficiency anemia (IDA). The recent development of automated systems for hematology analysis has made it possible to measure reticulocyte hemoglobin equivalent (RET-He), which is thought to reflect iron content in reticulocytes, in the same sample used for complete blood count tests. Aim of the work We aimed to assess the role of RET- He in diagnosis of iron deficiency anemia. Subjects and Methods Blood samples were obtained from 102 subjects. Patients were classified into three groups: IDA, ID, and anemia of chronic disorder (ACD). In addition 20 age and sex matched healthy volunteers were enrolled as control. RET- He was assessed by Sysmex XN1000 hematology analyzer. Results Patients in the IDA group had significantly lower RET-He levels than those in the control group. RET-He was correlated with serum ferritin in the IDA and ID groups. The area under the curve for RET-He was 0.883. The cut-off value of RET- He for detecting IDA was ≤ 26.5 pg with 80% sensitivity and 90% specificity. Conclusion RET-He facilitates the diagnosis of IDA with high accuracy and may be a clinically useful marker for determining IDA.

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