The Role of Discriminant Functions in Screening Beta Thalassemia Trait and Iron Deficiency Anemia Among Laboratory Samples

Overview

Journal J Lab Physicians

Specialty Pathology

Date 2017 Jul 15

PMID 28706390

Citations 8

Authors

Ashwani Kumar

Debarshi Saha

Jyoti Kini

Nirupama Murali

Shrijeet Chakraborti

Deepa Adiga

Affiliations

Soon will be listed here.

Abstract

Introduction: Most important differential diagnosis for microcytosis and hypochromia is beta thalassemia trait (BTT) and iron deficiency anemia.

Aim: To study the utility of discriminant functions (DFs) and red cell indices in distinguishing BTT and iron deficiency anemia.

Methods: The study is observational (cross sectional). A total of 350 patients, 43 BTT, and 307 iron-deficiency anemia reflecting actual disease prevalence were included. Their complete red blood cell parameters, hemoglobin A2, and serum ferritin level wherever required were obtained. Receiver operator characteristic curve was drawn for each DF and results compared with other studies.

Results: Among the six DFs, the highest sensitivity (97.7%) and specificity (98.6%) was shown, respectively, by Shine and Lal (S and L) and England and Fraser index (E and F) in identifying cases of BTT. Youden index of the Mentzer index (MI) was the highest (69.0) and S and L, the lowest (13.2) indicating MI to be the most efficient and the S and L, the least in differentiating the two entities. Red cell distribution width index (RDWI) showed the highest accuracy (91.6%), whereas S and L showed the least accuracy (29.6%).

Conclusion: MI was the most efficient in discriminating BTT from iron deficiency anemia (IDA). RDWI stands to be the most accurate. S and L could at best be used as screening tool rather than DF. No study except one agreed with us because convenient sampling used in other studies generated bias in their results. Statistically, this study bears far more relevance than other studies because the sample distribution reflects the prevalence of IDA and BTT in the community.

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References

Beyan C, Kaptan K, Ifran A . Predictive value of discrimination indices in differential diagnosis of iron deficiency anemia and beta-thalassemia trait. Eur J Haematol. 2007; 78(6):524-6. DOI: 10.1111/j.1600-0609.2007.00853.x. View

Schoorl M, Schoorl M, Linssen J, Martinez Villanueva M, NoGuera J, Martinez P . Efficacy of advanced discriminating algorithms for screening on iron-deficiency anemia and β-thalassemia trait: a multicenter evaluation. Am J Clin Pathol. 2012; 138(2):300-4. DOI: 10.1309/AJCP20UTTCAYKUDX. View

Linares M, Miguel A . Red cell distribution width analysis in differentiation between iron deficiency and thalassemia minor. Acta Haematol. 1988; 80(1):59. DOI: 10.1159/000205600. View

Ehsani M, Shahgholi E, Rahiminejad M, Seighali F, Rashidi A . A new index for discrimination between iron deficiency anemia and beta-thalassemia minor: results in 284 patients. Pak J Biol Sci. 2009; 12(5):473-5. DOI: 10.3923/pjbs.2009.473.475. View

Jayabose S, Mahmoud M, Levendoglu-Tugal O, Sandoval C, Ozkaynak F, Giamelli Jr J . Corticosteroid prophylaxis for neurologic complications of intravenous immunoglobulin G therapy in childhood immune thrombocytopenic purpura. J Pediatr Hematol Oncol. 1999; 21(6):514-7. View

Mentzer Jr W . Differentiation of iron deficiency from thalassaemia trait. Lancet. 1973; 1(7808):882. DOI: 10.1016/s0140-6736(73)91446-3. View

Srivastava P . Differentiation of thalassaemia minor from iron deficiency. Lancet. 1973; 2(7821):154-5. DOI: 10.1016/s0140-6736(73)93104-8. View

SHINE I, Lal S . A strategy to detect beta-thalassaemia minor. Lancet. 1977; 1(8013):692-4. DOI: 10.1016/s0140-6736(77)92128-6. View

Pearson H, OBrien R, McIntosh S . Screening for thalassemia trait by electronic measurement of mean corpuscular volume. N Engl J Med. 1973; 288(7):351-3. DOI: 10.1056/NEJM197302152880706. View

10.

Kotwal J, Saxena R, Choudhry V, Dwivedi S, Bhargava M . Erythrocyte indices for discriminating thalassaemic and non-thalassaemic microcytosis in Indians. Natl Med J India. 2000; 12(6):266-7. View

11.

Roberts G, El Badawi S . Red blood cell distribution width index in some hematologic diseases. Am J Clin Pathol. 1985; 83(2):222-6. DOI: 10.1093/ajcp/83.2.222. View

12.

Okan V, Cigiloglu A, Cifci S, Yilmaz M, Pehlivan M . Red cell indices and functions differentiating patients with the beta-thalassaemia trait from those with iron deficiency anaemia. J Int Med Res. 2009; 37(1):25-30. DOI: 10.1177/147323000903700103. View

13.

England J, Fraser P . Differentiation of iron deficiency from thalassaemia trait by routine blood-count. Lancet. 1973; 1(7801):449-52. DOI: 10.1016/s0140-6736(73)91878-3. View

14.

Demir A, Yarali N, Fisgin T, Duru F, Kara A . Most reliable indices in differentiation between thalassemia trait and iron deficiency anemia. Pediatr Int. 2002; 44(6):612-6. DOI: 10.1046/j.1442-200x.2002.01636.x. View

15.

Lafferty J, Crowther M, Ali M, Levine M . The evaluation of various mathematical RBC indices and their efficacy in discriminating between thalassemic and non-thalassemic microcytosis. Am J Clin Pathol. 1996; 106(2):201-5. DOI: 10.1093/ajcp/106.2.201. View

16.

Verma I, Choudhry V, Jain P . Prevention of thalassemia: a necessity in India. Indian J Pediatr. 1992; 59(6):649-54. DOI: 10.1007/BF02859390. View

17.

Ghosh A, Woo J, Wan C, MacHenry C, Wong V, Ma H . Evaluation of a prenatal screening procedure for beta-thalassaemia carriers in a Chinese population based on the mean corpuscular volume (MCV). Prenat Diagn. 1985; 5(1):59-65. DOI: 10.1002/pd.1970050111. View

18.

Yeo G, Tan K, Liu T . The role of discriminant functions in screening for beta-thalassaemia traits during pregnancy. Singapore Med J. 1995; 36(6):615-8. View

19.

Klee G, Fairbanks V, PIERRE R, OSullivan M . Routine erythrocyte measurements in diagnosis of iron-deficiency anemia and thalassemia minor. Am J Clin Pathol. 1976; 66(5):870-7. DOI: 10.1093/ajcp/66.5.870. View

20.

Ricerca B, Storti S, DOnofrio G, Mancini S, Vittori M, Campisi S . Differentiation of iron deficiency from thalassaemia trait: a new approach. Haematologica. 1987; 72(5):409-13. View