Cut off Determination of Discrimination Indices in Differential Diagnosis between Iron Deficiency Anemia and β- Thalassemia Minor
Abstract
Objective: The two most frequent hypochromic microcytic anemias are β- thalassemia minor (BTM) and iron deficiency anemia (IDA). Several discrimination indices have been proposed to quickly discriminate these similar entities via parameters obtained from automated blood count analyzers. The aim of this study to evaluate the diagnostic reliability of ten discrimination indices in the differentiation of Iron deficiency anemia (IDA) from β Thalassemia Minor (BTM).
Methods: This study was conducted on 100 BTM and 70 cases with IDA in southern Iran. This evaluation was conducted through calculation sensitivity, specificity, positive and negative predictive value, Likelihood ratio positive, likelihood ratio negative and also we recalculated cut-off values for every formulas in our population and determination of Area Under Curve related to receiver operative characteristic (ROC) curves.
Results: ROC for each discrimination indices show that, the highest diagnostic value based on the area under the ROC curve are related to the Green & King, England & Frazer and then Sirdah formulas (0.909, 0.907, 0.904, respectively) in South-east of Iran, and relatively different cut-off values for every formula.
Conclusion: The spectrum β thalassemia mutations in each population can affect on various RBC indices, therefore, it is suggested to determine cut-off value for every formula in different populations.
Cao A, Rosatelli MC, Monni G, Galanello R. Screening for thalassemia: a model of success. Obstet Gynecol Clin North Am 2002; 29(2):305-28, vi-vii.
Srivastava PC. Differentiation of thalassaemia minor from iron deficiency. Lancet 1973; 2(7821):154-5.
Shine I, Lal S. A strategy to detect beta-thalassaemia minor. Lancet 1977; 1(8013):692-4.
Ricerca BM, Storti S, d'Onofrio G, et al. Differentiation of iron deficiency from thalassaemia trait: a new approach. Haematologica 1987; 72(5):409-13.
Nesa A, Munir SF, Sultana T, et al. Role of discrimination indices in differentiation of beta thalassaemia trait and iron deficiency anaemia. Mymensingh Med J 2011; 20(1):110-4.
Mentzer WC, Jr. Differentiation of iron deficiency from thalassaemia trait. Lancet 1973; 1(7808):882.
England JM, Bain BJ, Fraser PM. Differentiation of iron deficiency from thalassaemia trait. Lancet 1973; 1(7818):1514.
Ehsani MA, Shahgholi E, Rahiminejad MS, et al. 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.
Sirdah M, Tarazi I, Al Najjar E, Al Haddad R. Evaluation of the diagnostic reliability of different RBC indices and formulas in the differentiation of the beta-thalassaemia minor from iron deficiency in Palestinian population. Int J Lab Hematol 2008; 30(4):324-330.
Bessman JD, Gilmer PR, Jr., Gardner FH. Improved classification of anemias by MCV and RDW. Am J Clin Pathol 1983; 80(3):322-6.
Demir A, Yarali N, Fisgin T, et al. Most reliable indices in differentiation between thalassemia trait and iron deficiency anemia. Pediatr Int 2002; 44(6):612-6.
Lafferty JD, Crowther MA, Ali MA, 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.
Ghotbi N, Tsukatani T. Evaluation of the national health policy of thalassaemia screening in the Islamic Republic of Iran. East Mediterr Health J 2005; 11(3):308-18.
Habibzadeh F, Yadollahi M, Merat A, Haghshenas M. Thalassemia in Iran: an overview. Arch Iran Med 1998; 1(1):27-33.
Miri-Moghaddam E, Zadeh-Vakili A, Nikravesh A, et al. Sistani population: a different spectrum of beta-thalassemia mutations from other ethnic groups of Iran. Hemoglobin 2013; 37(2):138-47.
Miri-Moghaddam E, Eshghi P, Sanei Moghaddam E, Hashemi SM. Prevalence of hemoglobinopathies in Sistan and Balouchistan province in the southeast of Iran. Sci J Iran Blood Transfus Organ 2013; 9(4):406-413.
Tan GB, Aw TC, Dunstan RA, Lee SH. Evaluation of high performance liquid chromatography for routine estimation of haemoglobins A2 and F. J Clin Pathol 1993; 46(9):852-6.
Miri-Moghaddam E, Naderi M, Izadi S, Mashhadi M. Causes of new cases of major thalassemia in sistan and balouchistan province in South-East of iran. Iran J Public Health 2012; 41(11):67-71.
Rathod DA, Kaur A, Patel V, et al. Usefulness of cell counter-based parameters and formulas in detection of beta-thalassemia trait in areas of high prevalence. Am J Clin Pathol 2007; 128(4):585-9.
Rosatelli C, Leoni GB, Tuveri T, et al. Heterozygous beta-thalassemia: relationship between the hematological phenotype and the type of beta-thalassemia mutation. Am J Hematol 1992; 39(1):1-4.
Rund D, Filon D, Strauss N, et al. Mean corpuscular volume of heterozygotes for beta-thalassemia correlates with the severity of mutations. Blood 1992; 79(1):238-43.
Miri-Moghaddam E, Zadeh-Vakili A, Rouhani Z, et al. Molecular basis and prenatal diagnosis of β- thalassemia among Balouch population in Iran. Prenat Diagn 2011; 31:788-791.
Van Vranken M. Evaluation of microcytosis. Am Fam Physician; 82(9):1117-22.
Roberts GT, El Badawi SB. Red blood cell distribution width index in some hematologic diseases. Am J Clin Pathol 1985; 83(2):222-6.
Raper AB. Differentiation of iron-deficiency anaemia from thalassaemia trait. Lancet 1973; 1(7806):778.
Novak RW. Red blood cell distribution width in pediatric microcytic anemias. Pediatrics 1987; 80(2):251-4.
Miguel A, Linares M, Miguel A, Miguel-Borja JM. Red cell distribution width analysis in differentiation between iron deficiency and thalassemia minor. Acta Haematol 1988; 80(1):59.
Marti HR, Fischer S, Killer D, Burgi W. Can automated haematology analysers discriminate thalassaemia from iron deficiency? Acta Haematol 1987; 78(2-3):180-3.
Junca J, Flores A, Roy C, et al. Red cell distribution width, free erythrocyte protoporphyrin, and England-Fraser index in the differential diagnosis of microcytosis due to iron deficiency or beta-thalassemia trait. A study of 200 cases of microcytic anemia. Hematol Pathol 1991; 5(1):33-6.
Houwen B. The use of inference strategies in the differential diagnosis of microcytic anemia. Blood Cells 1989; 15(3):509-27; discussion 527-32.
Flynn MM, Reppun TS, Bhagavan NV. Limitations of red blood cell distribution width (RDW) in evaluation of microcytosis. Am J Clin Pathol 1986; 85(4):445-9.
Bessman JD, McClure S, Bates J. Distinction of microcytic disorders: comparison of expert, numerical-discriminant, and microcomputer analysis. Blood Cells 1989; 15(3):533-40.
Ntaios G, Chatzinikolaou A, Saouli Z, et al. Discrimination indices as screening tests for beta-thalassemic trait. Ann Hematol 2007; 86(7):487-91.
Matos JF, Dusse LM, Stubbert RV, et al. Comparison of discriminative indices for iron deficiency anemia and beta thalassemia trait in a Brazilian population. Hematology 2013; 18(3):169-74.
Shen C, Jiang YM, Shi H, et al. Evaluation of indices in differentiation between iron deficiency anemia and beta-thalassemia trait for Chinese children. J Pediatr Hematol Oncol 2010; 32(6):e218-22.
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| Issue | Vol 8, No 2 (2014) | |
| Section | Articles | |
| Keywords | ||
| Anemia Cutoff Discrimination formulas Iron deficiency Microcytosis β-thalassemic trait | ||
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