A New Index for Discrimination Between Iron Deficiency Anemia and Beta-Thalassemia Minor: Results in 284 Patients

Abstract

The present study reports the results in 284 patients of applying a recently developed index, MCV-(10 x RBC), for discrimination between beta-thalassemia trait (beta-TT) and Iron Deficiency Anemia (IDA), the two most common causes of microcytic hypochromic anemias. A total of 284 carefully selected patients (130 patients with IDA and 154 with beta-TT) were studied. Sensitivity, specificity and Youden's index were compared between the proposed index and four other indices, namely England-Fraser, Mentzer, Srivastava and RBC count. The new index correctly identified 263 (92.96%) patients, standing inferior only to Mentzer which correctly diagnosed 269 (94.71%) patients. The best discrimination index according to Youden's criteria was Mentzer (Youden's index = 90.1) followed by the new index (Youden's index = 85.5). There are remarkable inconsistencies among the results obtained in different studies. Larger studies are needed to establish the optimal discrimination index as well as to confirm the results obtained in the present study. Nevertheless, the epidemiological indices of the proposed discrimination index and the simplicity of its calculation make it acceptable for use in Iran.

Hematological Indices for Differential Diagnosis of Beta Thalassemia Trait and Iron Deficiency Anemia

“…In their study, the Mentzer and Ehsani et al indices were able to correctly diagnose 94.7% and 92.9% of cases, respectively, and both are easy to calculate [11]. Similar results (Mentzer index: sensitivity, 90.9%; specificity, 80.3%) were found by Ghafouri et al [19].…”

“…The differential values for each discrimination index were applied as defined in the original published reports: red blood distribution width index (RDWI), Mentzer index [4], the Shine and Lal index [5], the England and Fraser index [6], the Srivastava index [7], the Green and King index [8], the Ricerca et al index [9], and the Sirdah et al index [10]. The Ehsani et al index [11], mean density of hemoglobin per liter of blood (MDHL), mean cell hemoglobin density (MCHD) [12], and RBC count were evaluated and compared. The values of each index required to distinguish between β -TT and IDA and the number and proportion of correctly identified patients (true positives) calculated using these indices are shown in Table 3.…”

Evaluation of the diagnostic reliability of Mentzer index for Beta thalassemia trait followed by HPLC

“…In 2009, Ehsani et al showed that the best discrimination index according to Youden's criteria was the Mentzer index (90.1%), followed by the Ehsani et al index (85.5%). In their study, the Mentzer and Ehsani et al were able to correctly diagnose 94.7% and 92.9% of cases, respectively [12]. Similar results (Mentzer index: sensitivity, 90.9%; specificity, 80.3%) were found by Ghafouri et al [13].…”

“…The purpose of using indices to discriminate anemia is to detect subjects who have a high probability of requiring appropriate follow-up and to reduce unnecessary investigative costs. Since 1970, a number of complete blood count indices have been proposed as simple and inexpensive tools to determine whether a blood sample is more suggestive of -TT or IDA [12,[18][19][20][21][22][23][24][25].…”

A new index to discriminate between iron deficiency anemia and thalassemia trait

“…In an attempt to simplify the differential diagnosis between IDA and TT, several indices using blood cell count parameters have been suggested 9, 10, 11, 12, 13, 14, 15, 16. The formula developed by Green & King {[(MCV 2 ) × RDW]/(Hb × 100) where MCV is mean corpuscular volume, RDW is RBC distribution width and Hb is hemoglobin} has, according to many studies, a good performance 16, 17, 18.…”