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Sensitivity, specificity and efficiency of different discriminative indexes in differentiation of thalassemia trait from iron deficiency anemia
Monica Dogaru,Rodica Talmaci,Daniel Coriu,Sorina Badelita
Biointerface Research in Applied Chemistry , 2011,
Abstract: 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 β- thalassemia trait.
Coexisting Iron Deficiency Anemia and Beta Thalassemia Trait: Effect of Iron Therapy on Red Cell Parameters and Hemoglobin Subtypes  [PDF]
Sarika Verma,Ruchika Gupta,Madhur Kudesia,Alka Mathur,Gopal Krishan,Sompal Singh
ISRN Hematology , 2014, DOI: 10.1155/2014/293216
Abstract: Background. Coexistence of iron deficiency anemia (IDA) and beta thalassemia trait (BTT) has been the topic of few studies. However, no study from our country was found evaluating the effect of iron therapy in patients with concomitant IDA and BTT. Methods. Over a period of two years, 30 patients with concomitant IDA and BTT were included. All the patients had a complete blood count, serum iron studies, and thalassemia screening using BIORADTM hemoglobin testing system. The patients received oral iron therapy in appropriate dosages for a period of twenty weeks, after which all the investigations were repeated. Appropriate statistical methods were applied for comparison of pre- and posttherapy data. Results. All except two patients were adults with a marked female preponderance. Oral iron therapy led to statistically significant improvement in hemoglobin, red cell indices ( ), and marked change in serum iron, ferritin, and HbA2 levels ( ). There was a significant reduction in the total iron binding capacity levels. Conclusion. The present study shows the frequent occurrence of iron deficiency anemia in patients with beta thalassemia trait, which can potentially confound the diagnosis of the latter. Hence, iron deficiency should be identified and rectified in patients with suspicion of beta thalassemia trait. 1. Introduction Thalassemia syndromes and iron deficiency anemia (IDA) are the two most common etiologies of microcytic hypochromic anemia in children and adults. It has long been considered that iron deficiency does not exist in thalassemia syndromes, including thalassemia major as well as trait. However, studies have shown the occurrence of iron deficiency in patients with beta thalassemia trait (BTT). Earlier authors have demonstrated lower initial hemoglobin levels in patients with coexisting IDA and BTT [1–3]. This has been explained by the lack of hemopoietic nutrients due to iron deficiency superimposing on the imbalance in globin chain synthesis [4]. Similar changes have also been shown in other red cell parameters, serum iron, ferritin, and total iron binding capacity. These changes have also been demonstrated to improve after adequate iron replacement therapy [1, 2, 5]. HbA2 levels have been reported to be lower in patients with coexisting IDA and BTT, with improvement in levels after iron therapy [1, 6]. However, other studies have shown no significant difference in HbA2 levels in such patients [7, 8]. The reduction in HbA2 levels in patients with concomitant BTT and IDA has been suggested to interfere in the diagnosis of the former. A
Evaluation of NESTROFT as a marker of differentiation between β- Thalassemia Trait & Iron Deficiency Anemia
Afshan Sumera,Sulaiman Ahmed,SM Adnan Ali,Rafiq Khanani
International Journal of Collaborative Research on Internal Medicine & Public Health , 2012,
Abstract: Objective: To evaluate efficiency of Naked Eye Single Tube Red cell Osmotic Fragility Test (NESTROFT) as a marker of clinical differentiation between β-thalassemia trait (BTT) & Iron deficiency anemia; to rule out potential bias of NESTROFT with regards to its sensitivity and specificity in cases with coincident iron deficiency anemia. Materials & Methods: This was a case control study on 503 subjects, carried out at Dow Diagnostics Research & Reference Lab (DDRRL) during the period from December 2009 to August 2010. Subjects were categorized into three groups based on red cell indices, preformed on automated hematology analyser (cell tac alpha, Nihon Kohden, Japan). Group I, comprised of control subjects with normal red cell indices, Group II comprised of case subjects with microcytosis MCV < 80 fL, normal ferritin levels and HbA2 > 3.5% on Hb Electrophoresis and Group III included subjects with proven Iron Deficiency Anemia (IDA) i.e., low serum ferritin levels; hemogram & peripheral smears suggestive of iron deficiency anemia. NESTROFT was performed on all cases. Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value were calculated. Differential Diagnosis of IDA & BTT was justified by testing serum Ferritin and Hemoglobin Electrophoresis (showing increased HbA2 (≥3.5%) on cellulose acetate at an alkaline pH in cases with BTT). Data analysis was done on SPSS version 16.0. Results: Out of total 503 study subjects, microcytosis was found in 253 subjects. Majority of our microcytosis cases were with IDA n=174/253 (69%), while BTT cases were n=73/253 (29%). Sensitivity of NESTROFT was observed 93%, Specificity was 88% with Positive Predictive Value of 74% & Negative Predictive Value of 97%. NESTRODT was concomitantly positive in 13% IDA cases while it remained negative in 88% of subjects with IDA. For differentiation between IDA and BTT, red cell indices (MCV, MCH & MCHC), RBC count, & RDW% demonstrated statistically significant differences (P < 0.05). Conclusion: We conclude that NESTROFT is sensitive and specific marker in differentiating beta-thalassemia trait from iron deficiency anemia.
Simple Red Cell Indices in Screening and Discrimination of Iron Deficiency Anemia and Beta Thalassemia Trait in Egyptian Patients  [PDF]
Elham O. Hamed, Abeer Fakher El-Deen
Open Journal of Blood Diseases (OJBD) , 2019, DOI: 10.4236/ojbd.2019.91002
Abstract: Background: The most common causes of microcytic hypochromic anemia are iron deficiency anemia (IDA) and the beta-thalassemia trait (β-TT). The aim of the work is to compare the validity of the various simple indices to differentiate between iron deficiency anemia and β-thalassemia trait. Subjects and methods: A total of 2000 individuals were screened, by complete blood picture, measurement of serum iron, serum ferritin and hemoglobin separation; 224 patients were detected as having hypochromia and microcytosis. Among them 166 cases were IDA and 58 cases were β-TT. We calculated 11 discrimination indices. The number of correctly identified cases were determined, sensitivity, specificity, positive and negative predictive value and Youden’s index (YI) of each discrimination index was calculated. Results: The percentage of correctly diagnosed patients is highest for Matos and Carvalho index (MCI) (95.5%) which is closely followed by Red cell distribution width index (RDWI) (93.7%). The third high index was Green and King (GKI) (91.9%). Sensitivity, specificity of MCI for detection of IDA was found 98.8%, 87.9% respectively. For β-TT, sensitivity and specificity was found 86.2% and 98.8% respectively. The YI of MCI was found 85.9%. It is followed by RDWI; its sensitivity and specificity for detection of IDA was found 97.6%, 85.3%. For β-TT, sensitivity and specificity was found 82.7% and 97.6% respectively. The YI of RDWI was 81.6%. Conclusion: Matos and Carvalho index and RDWI are easily available automated cell-count-based indices coming out as good discriminator between IDA and β-TT in our study.
SALIVA IRON AND FERRITIN LEVELS IN PATIENTS WITH THALASSEMIA AND IRON DEFICIENCY ANEMIA  [cached]
Duran Canatan,Sevgi Kosaci Akdeniz
Mediterranean Journal of Hematology and Infectious Diseases , 2012, DOI: 10.4084/mjhid.2012.
Abstract: Most of the techniques for measuring iron accumulation such as serum iron concentration, iron binding capacity, serum ferritin level, liver biopsy are invasive and hard methods for patients. The changes in trace element concentrations in saliva at different systemic diseases shows the quantity of the element at the body. The aim of this study was to compare the levels of iron and ferritin in saliva and serum in patients with thalassemia and iron deficiency anemia. For this purpose, 35 healthy children as control group and 71 thalassemia major, 10 thalassemia intermedia and 15 thalassemia trait patients were involved. Their saliva and serum iron and ferritin levels were measured. There was no statistically difference between age and gender in all groups and control group (p>0.05). In all groups saliva iron levels are higher than serum iron levels(p<0.05). Furthermore there was a positive correlation betwen serum and saliva iron levels in thalassemia major, intermedia and trait groups ( p=0.000, r=0.972, r=0.720, r=0.955) and also there was a positive correlation between serum and saliva iron levels in control and iron deficiency group (p= 0.000, r= 0.885, r= 0.368). In conclusion, Saliva iron and ferritin levels increase as well as serum in patients with thalassemia and decrease in patients with iron deficiency anemia. Saliva can be used for diagnosis routinely to shows the iron overload and deficiency of the body and its easy applicability and also a non-invasive procedure is important advantage.
Comparing prevalence of Iron Deficiency Anemia and Beta Thalassemia Trait in microcytic and non-microcytic blood donors: suggested algorithm for donor screening  [cached]
Tiwari Aseem,Chandola Iva
Asian Journal of Transfusion Science , 2009,
Abstract: Background: The prevalence of microcytosis in donors and Iron Deficiency Anemia (IDA) and Beta-Thalassemia trait (BTT) in microcytic and non-microcytic donors has not been studied in India. The present study aims at finding the same. Materials and Methods: Initially 925 donor samples were evaluated on cell-counter. Of these, 50 were found to be microcytic. These were subjected to Ferritin and HbA2 determination. Subsequently, an additional 51, age-and-sex matched non-microcytic donor samples were selected to serve as controls. These were subjected to the same tests. Results: The prevalence of microcytosis was 5.4% (50/925). Among the microcytic donors, 52% were IDA, 36% BTT, 8% both, and 4% none. In case of non-microcytic donors 29.4% were IDA, 3.9% BTT, and 66.7% none. Conclusions: The study revealed a high prevalence of IDA and BTT in blood donors and a higher probability of finding these in the microcytic samples. This prompted authors to suggest an algorithm for screening of blood donors for IDA and BTT. The algorithm recommends doing an hemogram on all donor samples, routinely. Ferritin could be done only in microcytic samples. At levels lower than15 ng/ml, it is diagnosed as IDA, and therefore, HPLC is performed only for non-IDA samples with Ferritin levels higher than 15 ng/ml. By employing this algorithm, a substantial number of IDA and BTT could be diagnosed while keeping the number of Ferritin tests small and the number of HPLC tests even smaller and thus making it cost efficient.
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
Lima, Carmen Silvia Passos;Reis, Aparecida Ribeiro de Carvalho;Grotto, Helena Zerlotti Wolf;Saad, Sara Teresinha Ollala;Costa, Fernando Ferreira;
Sao Paulo Medical Journal , 1996, DOI: 10.1590/S1516-31801996000500005
Abstract: 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.
Evaluation of Discrimination Indices Validity for Screening of β-Thalassemia Trait
Ahmadi A.,Mirzaee Khalilabadi R.,Noorozi M.,Cohan N.
Qom University of Medical Sciences Journal , 2009,
Abstract: Background and Objectives: β-thalassemia trait (β-TT) and iron deficiency anemia (IDA) are the most common forms of microcytic anemia. Screening of β-thalassemia trait is important for medical counseling before marriage and preventing β-thalassemia major birth results. The most common problem in screening -TT is differentiating it from IDA. The aim of this study was to define the sensitivity, specificity, and predictive values of some discrimination indices for screening of β-TT in a sample of such patients.Methods: A total of 82 patients with microcytic anemia (MCV< 80 fl) were selected from Namazi Hospital, Shiraz, Iran, and 9 discrimination indices were calculated for them. The patients were divided intotwo groups: 42 patients with β-TT and 40 patients with IDA. The sensitivity, specificity, positive and negative predictive values and Youden,s index of each discrimination index were calculated for screening β-TT.Results: None of the discrimination indices showed 100% of sensitivity and specificity. But the Shin and Lal index, RDW index and RBC count showed the highest and valuable value for screening β-TT.Conclusion: Some discrimination indices like Shin and Lal index, RDW index and RBC index are valuable indices in screening β-TT.Keywords: Beta- Thalassemia; Anemia, Iron Deficiency.
Reticulocyte parameters in hemoglobinopathies and iron deficiency anemia
Cortellazzi, Laura C.;Teixeira, Sara M.;Borba, Ronaldo;Gervásio, Sirlei;Cintra, Carmem S.;Grotto, Helena Z. W.;
Revista Brasileira de Hematologia e Hemoterapia , 2003, DOI: 10.1590/S1516-84842003000200005
Abstract: flow cytometric reticulocyte analysis allows the evaluation of reticulocyte maturity. new reticulocyte parameters have been used in the diagnosis and management of anemias, in the bone marrow transplant setting and in the monitoring of iron replacement or erythropoiet in therapy. reticulocyte numbers and maturation levels have been studied in different hemoglobinopathies and the results have been correlated with the degree of ineffective erythropoiesis. in order to verify differences in reticulocyte parameters in various types of anemias and to test the absolute number of immature reticulocytes as a possible discriminating factor among various types of anemias, reticulocyte counts were performed on 219 samples from patients with sickle cell anemia (ss) (n= 62), hemoglobin s trait (n=9), sb thalassemia (n=7), hemoglobin sc disease (n=11), b thalassemia trait (n=33) and iron deficiency anemia (n= 47), and non-anemic individuals (n= 50). mean fluorescence index (mfi) was defined as representative of the degree of reticulocyte immaturity and it was evaluated as a percentage and in absolute values. reticulocyte counts and mfi values were significantly higher in ss, sb thalassemic and sc groups when compared to controls, but not different among the three anemia groups. patients with hemoglobin s trait, iron deficiency anemia and b thalassemia trait showed reticulocyte parameters similar to the non-anemic group. there was no difference between the b thalassemic trait and iron deficiency anemia in relation to any parameters. mfi in absolute numbers were significantly higher in anemias that develop with the hemolytic process, although this was not evident in mfi percentage values. our results showed that the erythoid expansion in sickle cell diseases (ss, sc and sb thalassemia) leads to an enhanced immature reticulocyte release from bone marrow and that the phenomena is more evident by the mfi counting in absolute figures than in percentages. we concluded that the assessment
Reticulocyte parameters in hemoglobinopathies and iron deficiency anemia  [cached]
Cortellazzi Laura C.,Teixeira Sara M.,Borba Ronaldo,Gervásio Sirlei
Revista Brasileira de Hematologia e Hemoterapia , 2003,
Abstract: Flow cytometric reticulocyte analysis allows the evaluation of reticulocyte maturity. New reticulocyte parameters have been used in the diagnosis and management of anemias, in the bone marrow transplant setting and in the monitoring of iron replacement or erythropoiet in therapy. Reticulocyte numbers and maturation levels have been studied in different hemoglobinopathies and the results have been correlated with the degree of ineffective erythropoiesis. In order to verify differences in reticulocyte parameters in various types of anemias and to test the absolute number of immature reticulocytes as a possible discriminating factor among various types of anemias, reticulocyte counts were performed on 219 samples from patients with sickle cell anemia (SS) (n= 62), hemoglobin S trait (n=9), Sbeta thalassemia (n=7), hemoglobin SC disease (n=11), beta thalassemia trait (n=33) and iron deficiency anemia (n= 47), and non-anemic individuals (n= 50). Mean fluorescence index (MFI) was defined as representative of the degree of reticulocyte immaturity and it was evaluated as a percentage and in absolute values. Reticulocyte counts and MFI values were significantly higher in SS, Sbeta thalassemic and SC groups when compared to controls, but not different among the three anemia groups. Patients with hemoglobin S trait, iron deficiency anemia and beta thalassemia trait showed reticulocyte parameters similar to the non-anemic group. There was no difference between the b thalassemic trait and iron deficiency anemia in relation to any parameters. MFI in absolute numbers were significantly higher in anemias that develop with the hemolytic process, although this was not evident in MFI percentage values. Our results showed that the erythoid expansion in sickle cell diseases (SS, SC and Sb thalassemia) leads to an enhanced immature reticulocyte release from bone marrow and that the phenomena is more evident by the MFI counting in absolute figures than in percentages. We concluded that the assessment of reticulocyte maturity provides interesting data about the pathophysiology and erythopoietic response in different types of anemias.
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