Application of Hematological Indices for the Differential Diagnosis of Beta Thalassemia Trait and Iron Deficiency Anemia
Keywords:
Ehsani’s Formula, Hematological Indices, Iron deficiency anemia, ß-thalassemia trait, Mentzer’s index, Shine and Lal IndexAbstract
Objective: To apply various hematological indices for the differential diagnosis of ß-Thalassemia trait (ß-TT) and iron deficiency
anemia (IDA).
Methodology: This retrospective descriptive study was conducted at Dar-ul-Sehat Hospital, Gulistan -e- Johar, Karachi. We
retrospectively analyzed complete blood count (CBC) of 2480 patients, who came to the OPD for various problems during the
year 2014 from January to December so as to identify hypochromic microcytic patients. Mentzer’s index (MI), Shine and Lal
index (S and L index) and Ehsani’s formula were applied on the CBC report of identified microcytic hypochromic patients.
Results: It was found that among a total of 2840 patients, 385 (13.55%) patients were suffering from hypochromic microcytic
anemia identified on their CBC report. These included 44 males (6.74%), 300 females (33.33%) and 41 (14.48%) children.
Application of Mentzer’s index (MI), Shine and Lal index (S and L index) and Ehsani’s formula screened the hypochromic
microcytic patients into patients suffering from ß-Thalassemia trait and Iron deficiency Anemia.
Conclusion: Application of hematological indices can be taken as the most useful method for differentiating ß-TT from IDA
by simply considering CBC report.
References
World Health Organization. Geneva, Switzerland; Guide- line: Intermittent Iron Supplementation for Preschool and School Age Children. e-Library of Evidence for Nutrition Actions (eLENA). World Health Organization; 2011
Khambalia AZ, Aimone AM, Zlotkin SH. Burden of anemia among indigenous populations Nutr Rev. 2011; 69 (12): 693-719
Matos JF, Dusse LM, Stubbert RVB, Ferreira MR, Coura-Vital W, Ferreira MR, et al. Comparison of discriminative indices for iron deficiency anemia and beta thalassemia trait in a Brazilian population.Hematology, 2013; 18:169-174
Nalbantoglu B, Guzel S, Buyukyalcin V, Donma MM, Guzel EC, Nalbantoglu, et al. Indices used in differentia- tion of thalassemia trait from iron deficiency anemia in pediatric population are they reliable? Pediatr Hematol Oncol, 2012; 29:472-478
Charles A. Linker. Blood: Current med diagnosis and treatment: Blood-Anemias. Lange Med Pub 2004; 43:46 2-463
Ansari SH, Shamsi TS, Ashraf M, Bohray M, Farzana T, Khan MT, et al. Molecular epidemiology of B- thalassemia in Pakistan. Far reaching implication. Int J Mol Epidemiol Genet 2011; 2: 403-8
Batebi A, Pourreza A, Esmailian R. Discrimination of beta-thalassaemia minor and iron deficiency anemia by screening test for red blood cell indices.Turk J Med Sci 2012; 42: 275-280
Martin A, Thompson AA. Thalassemia. Pediatr clin North Am, 2013; 60: 1383-1391
Mentzer WC. Differentiation of iron deficiency anemia from thalassemia trait. Lancet 1973; 1: 882
Usman M, Moinuddin M, Ahmed SA. “Role of iron deficiency anemia in the propagation of beta thalassemia gene.” Korean Journal of Hematology 2011; 46(1): 41-44
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 B. thalassemia minor from iron deficiency in Palestinian Population.” International journal of laboratory Hematology, 2008; 30(4): 324-330
Urrechaga E, Borque L, Escanero JF. The role of automated measurement of RBC subpopulations in differential diagnosis of microcytic anemia and ß-thalassemia screening. American Journal of Clinical Pathology 2011;
(3): 374–379
Khusun H, Yip R, Schultink W, Dillon DHS. World
Health Organization Hemoglobin Cut-Off Points for the Detection of Anemia Are Valid for an Indonesian Population.The American Society for Nutritional Sciences 1999
Vehapoglu Y, Ozgurham G, Demir AD, Uzuner S, Nursoy MA, Turkmen S, et al. Hematological Indices for differ- ential diagnosis of Beta thalassemia trait and Iron deficiency Anemia. Anemia 2014; 2014, Article ID 576738, 7 pages http://dx.doi.org/10.1155/2014/576738
Rahim F, Keikhaei B. Better differential diagnosis of iron deficiency anemia from beta-thalassemia trait. Turk J Hematol. 2009; 26(3):138-45
Penman BS, Gupta S, Weathered DJ. Epistasis and the sensitivity of phenotype screens for beta thalassemia. Br J Haematol 2015; 169(1):117-128
Rathod DA, Kaur A, Patel V, Ptel K, Kabrawala R, Patel M, et al. Usefulness of cell counter-based parameters
and formulas in detection of ß-thalassemia trait in areas of high prevalence. American Journal of Clinical Pathology 2007; 128(4):585–589
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 12-6
Huang TC, Wu YY, Chen YG, Lei SW, Wu SC, Ye RH, et al.. Discrimination index of microcytic anemia in young soldiers in a single institutional analysia. Plos One 2015; 10(2): e0114061
Miri-Moghaddam E Sargolzaie N. Cut off Determination of Discrimination Indices in Differential Diagnosis between Iron Deficiency Anemia and ß-Thalassemia. Int J Hematol Oncol Stem Cell Res. 2014;8(2): 27–32
Ehsani MA, Shahgholi E, Rahiminejad MS, 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
Suad MA, Anwar M Al-A, Doa’a A. Validity assessment of nine discriminant functions used for the differentiation between iron deficiency anemia and thalassemia minor. J Trop Pediatr 2007; 53: 93-7
Rahim F, Keikhaei B. Better differential diagnosis of iron deficiency anemia from beta thalassemia trait. Turk J Hematol 2009; 26:138-45
Ntaios G, Chatzinikolaou A, Saouli Z, Girtovitis F, Tsapanidou M, Kaiafa G, et al. Discrimination indices as screening tests for beta-thalassemic trait. Ann Hematol 2007; 86: 487-91
Beyan C, Kaptan K, Ifran A. Predictive value of discrim- ination indices in differential diagnosis of iron deficiency anemia and beta-thalassemia trait. Eur J Haematol 2007; 78: 524-6
Garg S, Srivastava A, Singh S, Jaiswal R, Singh YK. Role of hematological Indices in the screening of ß-thalassemia Minor (trait) and iron deficiency Anemia. American research journal of Hematology 2016; Volume 2016: 1-5
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2017 Sajid Abbas, Shaista Khurrum, Tahira Zamir
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0 
