Evaluation of diagnostic accuracy tests of erythrocyte indexes in the differential diagnosis of beta thalassemia minor and iron deficiency anemia: A preliminary report

Year 2021, Volume: 46 Issue: 3, 1009 - 1017, 30.09.2021

Tevfik Balcı , Durmuş Ayan , Cevdet Türkyürek Ergül Bayram

https://doi.org/10.17826/cumj.905007

Cited By: 1

Abstract

Purpose: The most common anemias are iron deficiency anemia (IDA) and beta-thalassemia minor (BTm). A correct differantiation of them is important in terms of preventing unnecessary iron treatment and also preventing thalassemia disease. Considering the financial limitations specifically in countries with high prevalence of thalassemia, mathematical indices, which are simpler solutions, have been used to achieve a differential diagnosis.
Materials and Methods: Total of 71 cases eligible for inclusion criteria were included in the study and 11 indices were examined. 46 of the cases were in the BTm-group and 25 of the cases were in the IDA-group. The BTm-group were accepted as positive-patient-group and the IDA-group were accepted as control-group. Diagnostic criteria were evaluated with erythrocyte indices.
Results: The highest Youden Index was seen in the Sirdah index (89.48%), followed by two identical performances of the Ehsani and the Mentzer indices (84.%), indicating that these three indices showed the best diagnostic performance. There were two indices with a low performance (DOR<10): The Bessmann and Ricerca indices.
Conclusion: Adding appropriate indices to complete blood count (CBC) results before further examinations will be beneficial in terms of efficient use of resources.

Keywords

erythrocyte indices, differential, diagnosis, beta thalassemia minor, iron deficiency anemia

Beta talasemi minör ve demir eksikliği anemisinin ayırıcı tanısında eritrosit indekslerinin tanısal doğruluk testlerinin değerlendirilmesi: ön çalışma raporu

Abstract

Amaç: En sık görülen anemiler demir eksikliği anemisi (DEA) ve beta-talasemi minördür (BTm). Bunların doğru bir şekilde ayırt edilmesi, gereksiz demir tedavisinin önlenmesi ve talasemi hastalığının önlenmesi açısından önemlidir. Özellikle talasemi prevalansının yüksek olduğu ülkelerdeki finansal kısıtlılıklar göz önüne alındığında, ayırıcı tanıya ulaşmak için daha basit çözümler olan matematiksel indeksler kullanılmıştır.
Gereç ve Yöntem: Dahil edilme kriterlerine uygun toplam 71 vaka çalışmaya dahil edildi ve 11 indeks incelendi. Vakaların 46'sı BTm grubunda, 25'i ise IDA grubundaydı. BTm grubu pozitif hasta grubu, DEA grubu kontrol grubu olarak kabul edildi. Tanı kriterleri eritrosit indeksleri ile değerlendirildi.
Bulgular: En yüksek Youden İndeksi Sirdah indeksinde (%89,48) görüldü, ardından Ehsani ve Mentzer indekslerinin iki özdeş performansı (%84,00) bu üç indeksin en iyi tanısal performansı gösterdiğini gösteriyor. Düşük performanslı (DOR <10) iki endeks vardı: Bessmann ve Ricerca endeksleri.
Sonuç: İleri tetkiklerden önce tam kan sayımı (TKS) sonuçlarına uygun indekslerin eklenmesi kaynakların verimli kullanılması açısından faydalı olacaktır.

Keywords

Eritrosit indeksleri, ayırıcı, tanı, beta talasemi minör, demir eksikliği anemisi

References

• Referans1. DeLoughery TG. Microcytic anemia. N Engl J Med. 2014 Oct 2;371(14):1324-31.
• Referans2. Camaschella C. Iron deficiency. Blood. 2019 Jan 3;133(1):30-9.
• Referans3. Goddard AF, James MW, McIntyre AS, Scott BB; British Society of Gastroenterology. Guidelines for the management of iron deficiency anaemia. Gut. 2011 Oct;60(10):1309-16.
• Referans4. Ghosh K, Colah R, Manglani M, Choudhry VP, Verma I, Madan N et al. Guidelines for screening, diagnosis and management of hemoglobinopathies. Indian J Hum Genet. 2014 Apr;20(2):101-19.
• Referans5. Passarello C, Giambona A, Cannata M, Vinciguerra M, Renda D, Maggio A. Iron deficiency does not compromise the diagnosis of high HbA(2) β thalassemia trait. Haematologica. 2012 Mar;97(3):472-3.
• Referans6. England JM, Fraser PM. Differentiation of iron deficiency from thalassaemia trait by routine blood-count. Lancet. 1973 Mar 3;1(7801):449-52.
• Referans7. Mentzer WC Jr. Differentiation of iron deficiency from thalassaemia trait. Lancet. 1973 Apr 21;1(7808):882.
• Referans8. Srivastava PC. Differentiation of thalassaemia minor from iron deficiency. Lancet. 1973 Jul 21;2(7821):154-5.
• Referans9. Shine I, Lal S. A strategy to detect beta-thalassaemia minor. Lancet. 1977 Mar 26;1(8013):692-4.
• Referans10. Bessman JD, Feinstein DI. Quantitative anisocytosis as a discriminant between iron deficiency and thalassemia minor. Blood. 1979 Feb;53(2):288-93.
• Referans11. Ricerca BM, Storti S, d'Onofrio G, Mancini S, Vittori M, Campisi S et al. Differentiation of iron deficiency from thalassaemia trait: a new approach. Haematologica. 1987 Sep-Oct;72(5):409-13.
• Referans12. Green R, King R. A new red cell discriminant incorporating volume dispersion for differentiating iron deficiency anemia from thalassemia minor. Blood Cells. 1989;15(3):481-91; discussion 492-5.
• Referans13. Jayabose S, Mahmoud M, Levendoglu-Tugal O, Sandoval C, Ozkaynak F, Giamelli J Jr et al. Corticosteroid prophylaxis for neurologic complications of intravenous immunoglobulin G therapy in childhood immune thrombocytopenic purpura. J Pediatr Hematol Oncol. 1999 Nov-Dec;21(6):514-7.
• Referans14. 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 Aug;30(4):324-30.
• Referans15. 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 Mar 1;12(5):473-5.
• Referans16. Thein SL. Molecular basis of β thalassemia and potential therapeutic targets. Blood Cells Mol Dis. 2018 May;70:54-65.
• Referans17. Giambona A, Passarello C, Renda D, Maggio A. The significance of the hemoglobin A(2) value in screening for hemoglobinopathies. Clin Biochem. 2009 Dec;42(18):1786-96.
• Referans18. Walter SD. Properties of the summary receiver operating characteristic (SROC) curve for diagnostic test data. Stat Med. 2002 May 15;21(9):1237-56.
• Referans19. Schisterman EF, Perkins NJ, Liu A, Bondell H. Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology. 2005 Jan;16(1):73- 81.
• Referans20. Russo V, Melillo E, Papa AA, Rago A, Chamberland C, Nigro G. Arrhythmias and Sudden Cardiac Death in Beta-Thalassemia Major Patients: Noninvasive Diagnostic Tools and Early Markers. Cardiol Res Pract. 2019 Nov 30;2019:9319832.
• Referans21. Bolaman Z, Enli Y, Köseoğlu M, Koyuncu H, Aslan D. Prevalence of Beta Thalassemia Trait in Denizli. Turk J Haematol. 2001 Jun 5;18(2):85-8.
• Referans22. Hoffmann JJ, Urrechaga E, Aguirre U. Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia: a meta-analysis. Clin Chem Lab Med. 2015 Nov;53(12):1883-94.
• Referans23. 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 Aug;106(2):201-5.
• Referans124. d'Onofrio G, Zini G, Ricerca BM, Mancini S, Mango G. Automated measurement of red blood cell microcytosis and hypochromia in iron deficiency and beta-thalassemia trait. Arch Pathol Lab Med. 1992 Jan;116(1):84-9.
• Referans25. Cappellini MD. Hemoglobin, iron bilirubin. In Tietz Textbook of Clinical Chemistry and Molecular Diagnostics 6th Edition - E-Book (Nader Rifai):736. St. Louis, Missouri, USA, 2018.
• Referans26. Janel A, Roszyk L, Rapatel C, Mareynat G, Berger MG, Serre-Sapin AF. Proposal of a score combining red blood cell indices for early differentiation of beta-thalassemia minor from iron deficiency anemia. Hematology. 2011 Mar;16(2):123-7.
• Referans27. Jahangiri M, Rahim F, Malehi AS, Pezeshki SMS, Ebrahimi M. Differential Diagnosis of Microcytic Anemia, Thalassemia or Iron Deficiency Anemia: A Diagnostic Test Accuracy Meta-Analysis. Mod Med Lab J 2019;3(1):1-14.
• Referans28. Lippi G, Pavesi F, Bardi M, Pipitone S. Lack of harmonization of red blood cell distribution width (RDW). Evaluation of four hematological analyzers. Clin Biochem. 2014 Aug;47(12):1100-3.
• Referans29. Kneifati-Hayek J, Fleischman W, Bernstein LH, Riccioli A, Bellevue R. A model for automated screening of thalassemia in hematology (math study). Lab Hematol. 2007;13(4):119-23.
• Referans30. 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 Dec;44(6):612-6.