Should sex differences be considered when applying mathematical indices and formulas for discriminating β- thalassemia minor from iron deficiency?

Sirdah, Mahmoud M.; Mghari, Khaled Al; Abuzaid, Ali; Haddad, Rami M. Al

doi:10.1016/j.plabm.2018.01.004

Cited by 8 publications

(7 citation statements)

References 33 publications

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“…Matos et al, [6] reported that its sensitivity was 99.3%, Specificity 76.7% and YI was 76.0%, and the evaluation of this index by Arora et al, [22] showed high sensitivity to detect IDA (98.81%), excellent diagnostic accuracy and showing good applicability as screening tool in clinical practice. On the other hand Sirdah et al, [5] [25]. The present study found the MCI and RDWI indices to be best at differentiating IDA from β-TT.…”

Section: Discussionsupporting

confidence: 43%

“…Many attempts are done in the last decades to simplify the differential diagnosis between IDA and β-TT, and as a result, several indices using blood cell count parameters are made but none of these indices or formulas provided an absolute discrimination power. The index or formula that offered the highest discrimination power for one population, yet, it showed moderate or low power when applied to other populations [5]. Application of these indices depends on racial Open Journal of Blood Diseases [20].…”

Section: Discussionmentioning

confidence: 99%

“…However, definitive differential diagnosis between both disorders, especially in countries where both disorders are prevalent is based on the results of more reliable methods like hemoglobin electrophoresis, serum iron levels, serum ferritin and DNA studies for specific mutations. These confirmatory tests could be limited for mass screening programs, due to financial causes, especially in developing and poor countries with restricted resources [4] [5]. The development of indices with good diagnostic accuracy based on parameters derived from the blood cell counters would be useful in the clinical routine [6].…”

Section: Introductionmentioning

confidence: 99%

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Simple Red Cell Indices in Screening and Discrimination of Iron Deficiency Anemia and Beta Thalassemia Trait in Egyptian Patients

Hamed¹,

El-Deen²

2019

OJBD

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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.

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Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Simple Red Cell Indices in Screening and Discrimination of Iron Deficiency Anemia and Beta Thalassemia Trait in Egyptian Patients

Hamed¹,

El-Deen²

2019

OJBD

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“…In our study, blood count parameters, such as RBC, significantly differed between the females and males of each group. This finding is consistent with the study by Mahmoud, 22 which highlighted the importance of gender differences in the development and application of mathematical DFs. Therefore, to improve the diagnostic efficiency of TT, it is reasonable to stratify the cohort into male and female subcohorts before developing DFs that are unique to each group (Figure 1).…”

Section: Discussionsupporting

confidence: 93%

Cell count‐based parameters and algorithms for thalassaemia trait screening in the southern Chinese population

Yang

Zhou

et al. 2021

Int J Lab Hematology

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Introduction Thalassaemia trait (TT) is potential to be missed clinically, especially normocytic thalassaemia. We aimed to establish discriminant functions (DFs) and an algorithm for detecting microcytic or normocytic TT in epidemiological screening. Methods The receiver operating characteristics (ROC) curve analysis was used to determine the diagnostic performance of the proposed formulas in differentiating TT and nonthalassaemia (non‐TT). DFs combined the two blood count parameters with the highest performance, based on the area under the curve (AUC) value, into mathematical formulas, using logistic regression. The diagnostic efficacy of DFs was subsequently evaluated in 761 participants, and reliability (including adjusted agreement [AA] and Kappa values) and validity (including sensitivity, specificity, likelihood ratio and Youden's Index) were calculated. Results Among microcytic participants, the proposed DFs showed good diagnostic performance (in females: AUC = 0.892 [DF1 = 0.015 × RDW‐CV/RBC − 0.096 × RDW‐SD/RBC + 1.29], in males: AUC = 0.861 [DF2=−0.025 × RDW‐SD/RBC − 0.035 × MCV/RBC + 1.415]). Youden's Index, AA and Kappa values for microcytic TT detection were 0.72, 0.86, and 0.72 and 0.63, 0.81 and 0.63 for females and males, respectively. In normocytic participants with RDW‐CV/RBC ≤ 3.54, DF3=−0.38 × MCH−0.02 × MCHC+17.37 achieved AUC = 0.857 in females, whereas DF4 = 0.007 × MCV−0.113 × MCH+2.829 achieved AUC = 0.969 in males. The Youden's Index, AA and Kappa values for the proposed DFs for thalassaemia detection were 0.69, 0.84 and 0.67 in females, 0.76, 0.91 and 0.71 in males, respectively. Conclusion The proposed DFs performed well in the detection of TT among participants with microcytic and normocytic parameters and could be utilized in epidemiological study for TT.

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“…This could also be a possible explanation of variable results obtained in different studies. In our study equal numbers of male and female patients were taken to exclude this difference [24].…”

Section: Discussionmentioning

confidence: 99%

Role of Discrimination Indices in Screening of Beta Thalassemia Trait in Low-Resourced Areas of Pakistan

Mustafa¹,

Ali²,

Zulfiqar³

et al. 2019

Natl. j. health sci.

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Introduction: Thalassemia is a common inherited hemoglobinopathy in Pakistan. Despite various preventive measures taken, each year around 5000 new cases are diagnosed. The problem occurs due to undiagnosed beta Thalassemia carriers. This is because of lack of massive screening programs and unavailability of hemoglobin electrophoresis in different cities of Pakistan. The aim of this study is to assess the sensitivity of different discriminating indices in screening of beta Thalassemia trait. Material and Methods:The study was conducted at Pakistan Institute of Medical Sciences from January 2018-July 2018. All patients who were diagnosed as beta thalassemia trait through hemoglobin electrophoresis were included in the study. Seven discriminating indices were applied and sensitivity of each index was calculated. Results:The male to female ratio was 1:1. 88% of the cases had a positive family history of Thalassemia. Among the various indices used, Shine and Lal showed a sensitivity of 100%, followed by Ricerca (96.6%) and Ehsani (92.58%). The sensitivities of Mentzer, Srivasta, RDWI and MCHD were 92.56%, 91.70%, 79% and 70.9% respectively. The results of our study showed that Shine and Lal is the most sensitive index for screening beta Thalassemia trait. Conclusion:Shine and Lal index is useful to the clinicians as an initial screening tool of beta thalassemia trait. Such cases can then be referred to laboratories where hemoglobin electrophoresis facility is available.

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Should sex differences be considered when applying mathematical indices and formulas for discriminating β- thalassemia minor from iron deficiency?

Cited by 8 publications

References 33 publications

Simple Red Cell Indices in Screening and Discrimination of Iron Deficiency Anemia and Beta Thalassemia Trait in Egyptian Patients

Simple Red Cell Indices in Screening and Discrimination of Iron Deficiency Anemia and Beta Thalassemia Trait in Egyptian Patients

Cell count‐based parameters and algorithms for thalassaemia trait screening in the southern Chinese population

Role of Discrimination Indices in Screening of Beta Thalassemia Trait in Low-Resourced Areas of Pakistan

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