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Comparative Evaluation of Classification Indexes and Outlier Detection of Microcytic Anaemias in a Portuguese Sample. PROGRESS IN ARTIFICIAL INTELLIGENCE 2022. [DOI: 10.1007/978-3-031-16474-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Jahangiri M, Rahim F, Saki N, Saki Malehi A. Application of Bayesian Decision Tree in Hematology Research: Differential Diagnosis of β-Thalassemia Trait from Iron Deficiency Anemia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:6401105. [PMID: 34795791 PMCID: PMC8594992 DOI: 10.1155/2021/6401105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Several discriminating techniques have been proposed to discriminate between β-thalassemia trait (βTT) and iron deficiency anemia (IDA). These discrimination techniques are essential clinically, but they are challenging and typically difficult. This study is the first application of the Bayesian tree-based method for differential diagnosis of βTT from IDA. METHOD This cross-sectional study included 907 patients with ages over 18 years old and a mean (±SD) age of 25 ± 16.1 with either βTT or IDA. Hematological parameters were measured using a Sysmex KX-21 automated hematology analyzer. Bayesian Logit Treed (BLTREED) and Classification and Regression Trees (CART) were implemented to discriminate βTT from IDA based on the hematological parameters. RESULTS This study proposes an automatic detection model of beta-thalassemia carriers based on a Bayesian tree-based method. The BLTREED model and CART showed that mean corpuscular volume (MCV) was the main predictor in diagnostic discrimination. According to the test dataset, CART indicated higher sensitivity and negative predictive value than BLTREED for differential diagnosis of βTT from IDA. However, the CART algorithm had a high false-positive rate. Overall, the BLTREED model showed better performance concerning the area under the curve (AUC). CONCLUSIONS The BLTREED model showed excellent diagnostic accuracy for differentiating βTT from IDA. In addition, understanding tree-based methods are easy and do not need statistical experience. Thus, it can help physicians in making the right clinical decision. So, the proposed model could support medical decisions in the differential diagnosis of βTT from IDA to avoid much more expensive, time-consuming laboratory tests, especially in countries with limited recourses or poor health services.
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Affiliation(s)
- Mina Jahangiri
- Ph.D. Student, Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fakher Rahim
- Thalassemia & Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmaldin Saki
- Thalassemia & Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amal Saki Malehi
- Thalassemia & Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Xiao H, Wang Y, Ye Y, Yang C, Wu X, Wu X, Zhang X, Li T, Xiao J, Zhuang L, Qi H, Wang F. Differential diagnosis of thalassemia and iron deficiency anemia in pregnant women using new formulas from multidimensional analysis of red blood cells. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:141. [PMID: 33569443 PMCID: PMC7867939 DOI: 10.21037/atm-20-7896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Iron deficiency anemia (IDA) and thalassemia trait (TT) are the most common conditions of microcytic hypochromic anemia (MHA) in pregnant women. We used the BC-6800Plus analyzer to study the utility of erythrocyte and reticulocyte parameters for distinguishing TT from IDA in pregnant women. Methods A total of 454 anemic pregnant women, including 340 with IDA, 66 with β-thalassemia trait (β-TT) and 48 with α-thalassemia trait (α-TT), were included. Multiple comparisons among groups were performed, and diagnostic performance of parameters was determined using receiver operating characteristic (ROC) curve analysis, with P<0.05 indicating statistical significance. Results Reticulocyte production index (RPI) and the average volume of mature red blood cells (MCVm) in the IDA group were significantly higher than in the β-TT and α-TT groups. Red blood cell (RBC), reticulocyte percentage (Ret%), and RPI in the IDA group were significantly lower than in the α-TT and β-TT groups. We devised MHA 1=0.42× MCH -0.57× RPI -0.08× %MICROr -9.38 to distinguish IDA from α-TT. With a cut-off value of 0.61, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were 0.868, 90.9%, and 68.5%, respectively. We devised MHA 2=0.04× %MICROr +0.12× MCVm -13.76× Ret# -6.29 to distinguish IDA from β-TT. With a cut-off value of 0.55, the AUC, sensitivity, and specificity were 0.878, 81.3%, and 80.3%, respectively. Conclusions Erythrocyte indices and formulas can be used as initial methods for the differential diagnosis of TT and IDA. MHA 1 and MHA 2 were the most useful indices in the differential diagnosis of α-TT from IDA and β-TT from IDA in pregnant women.
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Affiliation(s)
- Haijun Xiao
- Department of Medical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Yidan Wang
- Department of Medical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Yi Ye
- Hematology Application and Research Department, Shenzhen Mindray Bio-Medical Electronic Co., Ltd, Shenzhen, China
| | - Chen Yang
- Department of Medical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Xiaolong Wu
- Hematology Application and Research Department, Shenzhen Mindray Bio-Medical Electronic Co., Ltd, Shenzhen, China
| | - Xiurong Wu
- Department of Medical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Xiaomei Zhang
- Hematology Application and Research Department, Shenzhen Mindray Bio-Medical Electronic Co., Ltd, Shenzhen, China
| | - Tianxi Li
- Department of Medical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Jianping Xiao
- Hematology Application and Research Department, Shenzhen Mindray Bio-Medical Electronic Co., Ltd, Shenzhen, China
| | - Ling Zhuang
- Department of Medical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Huan Qi
- Hematology Application and Research Department, Shenzhen Mindray Bio-Medical Electronic Co., Ltd, Shenzhen, China
| | - Feng Wang
- Department of Medical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
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Reis FMP, Andrade RRD, Rodrigues CFDS, Barbosa FT. Discriminant indexes to simplify the differential diagnosis between iron deficiency anemia and thalassemia minor in individuals with microcytic anemia. ACTA ACUST UNITED AC 2020; 66:1277-1282. [PMID: 33027458 DOI: 10.1590/1806-9282.66.9.1277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/22/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Microcytic anemias are very common in clinical practice, with iron deficiency anemia (IDA) and thalassemia minor (TT) being the most prevalent. Diagnostic confirmation of these clinical entities requires tests involving iron metabolism profile, hemoglobin electrophoresis, and molecular analysis. In this context, several discriminant indices have been proposed to simplify the differential diagnosis between IDA and TM. OBJECTIVE The aim of this paper was to demonstrate the clinical relevance of the use of discriminant indices in individuals with microcytic anemia to simplify the differential diagnosis between iron deficiency anemia and minor thalassemia. METHODS A bibliographic and cross-sectional search was performed in the PubMed, SciELO and LILACS databases, using the following descriptors: iron deficiency anemia, thalassemia minor, and differential diagnosis. RESULTS More than 40 mathematical indices based on erythrocyte parameters have been proposed in the hematological literature in individuals with microcytosis. Green & King indexes (IGK), Ehsani index, and erythrocyte count (RBC) had excellent performances, especially when their efficacy was observed in adults and children. CONCLUSIONS Confirmatory tests for differential diagnosis between IDA and TM require time-consuming and costly methods. Despite the excellent performances of IGK, Ehsani index, and RBC, none of them presented sufficient sensitivity and specificity to establish a diagnosis. However, they can provide a powerful additional tool for diagnostic simplification between IDA and TM.
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Affiliation(s)
- Fernando Minervo Pimentel Reis
- Farmacêutico-Bioquímico da Unidade de Emergência do Agreste Dr. Daniel Houly. Especialista em Hematologia Clínica, Arapiraca, AL, Brasil
| | | | | | - Fabiano Timbó Barbosa
- Doutor em Ciências da Saúde. Professor adjunto da disciplina Bases da Técnica Cirúrgica e Anestésica da Universidade Federal de Alagoas, Maceio, AL, Brasil
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Chen H, Zhang R, Cheng R, Xu T, Zhang T, Hong X, Zhao X, Wu Y, Cheng L, Hu T. Gingival bleeding and calculus among 12-year-old Chinese adolescents: a multilevel analysis. BMC Oral Health 2020; 20:147. [PMID: 32429918 PMCID: PMC7238592 DOI: 10.1186/s12903-020-01125-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/28/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Gingivitis is a common oral health problem, and untreated gingivitis can progress to periodontitis. The objectives of this study were to (1) explore associated factors of gingival bleeding and calculus among 12-year-old adolescents; (2) find predictive models for gingivitis management. METHODS Four thousand five hundred twenty-five subjects aged 12 in Sichuan Province were investigated. The questionnaire and clinical examination were applied in schools, and two-level logistic regression models were constructed to interpret the effect of individual and contextual factors on Chinese adolescents' gingival bleeding and calculus. RESULTS 46.63% (95%CI: 40.71, 51.60) and 66.94% (95%CI: 56.85, 67.45) of the subjects presented gingival bleeding and calculus, respectively. For the gingival bleeding cases, the model showed the significant associated indicators were hukou (OR = 0.61, 95% CI: 0.52-0.72), family size (OR = 1.41, 95% CI: 1.19-1.68), parental educational level (father: OR = 0.53, 95% CI: 0.45-0.63; mother: OR = 0.71, 95% CI: 0.59-0.86), tooth-brushing frequency (OR = 0.35, 95% CI: 0.26-0.48), dental floss use (OR = 0.58, 95% CI: 0.41-0.83), sugar-containing drink consumption (OR = 2.11, 95% CI: 1.80-2.49), and dental visit (OR = 1.44, 95% CI: 1.19-1.74). It also confirmed that gender (OR = 1.32, 95% CI: 1.13-1.54), hukou (OR = 0.69, 95% CI: 0.59-0.82), family size (OR = 1.34, 95% CI: 1.12-1.59), parental educational level (father: OR = 0.46, 95% CI: 0.39-0.54; mother: OR = 0.65, 95% CI: 0.59-0.82), tooth-brushing frequency (OR = 0.57, 95% CI: 0.42-0.78), dental floss use (OR = 0.66, 95% CI: 0.48-0.90) and sugar-containing drink consumption (OR = 1.30, 95% CI: 1.11-1.53) were associated factors for dental calculus. CONCLUSIONS Gingival bleeding and calculus were common in western Chinese adolescents. Socio-demographic factors including gender, hukou and family factors are strong determinants of gingival health in Chinese adolescents. In addition, health-related lifestyle behaviors such as healthy diet, good hygiene care and more dental visits are good predictors of better gingival status.
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Affiliation(s)
- Hong Chen
- Graduate Student in Department of Preventive Dentistry, West China School & Hospital of Stomatology, Sichuan University, Chengdu, China
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, PR China
| | - Rui Zhang
- Graduate Student in Department of Preventive Dentistry, West China School & Hospital of Stomatology, Sichuan University, Chengdu, China
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, PR China
| | - Ran Cheng
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, PR China
- Associate Professor in Department of Preventive Dentistry, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Ting Xu
- Graduate Student in Department of Preventive Dentistry, West China School & Hospital of Stomatology, Sichuan University, Chengdu, China
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, PR China
| | - Tao Zhang
- Graduate Student in Department of Preventive Dentistry, West China School & Hospital of Stomatology, Sichuan University, Chengdu, China
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, PR China
| | - Xiao Hong
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, PR China
- Associate Professor in Department of Preventive Dentistry, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Xing Zhao
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yunyun Wu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Li Cheng
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, PR China
- Associate Professor in Department of Preventive Dentistry, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Tao Hu
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, PR China.
- Professor in Department of Preventive Dentistry, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, PR China.
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Jahangiri M, Rahim F, Malehi AS. Diagnostic performance of hematological discrimination indices to discriminate between βeta thalassemia trait and iron deficiency anemia and using cluster analysis: Introducing two new indices tested in Iranian population. Sci Rep 2019; 9:18610. [PMID: 31819078 PMCID: PMC6901548 DOI: 10.1038/s41598-019-54575-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 11/15/2019] [Indexed: 01/24/2023] Open
Abstract
Although the discrimination between β-thalassemia trait (βTT) and Iron deficiency anemia (IDA) is important clinically, but it is challenging and normally difficult; so if a patient with IDA is diagnosed as βTT, then it is deprived of iron therapy. This study purpose was to evaluate the 26 different discriminating indices diagnostic function in patients with microcytic anemia by using accuracy measures, and also recommending two distinct new discriminating indices as well. In this study, 907 patients were enrolled with the ages over 18-year-old with either βTT or IDA. Twenty-six discrimination indices diagnostic performance presented in earlier studies, and two new indices were introduced in this study (CRUISE index and index26) in order to evaluate the differential between βTT and IDA by using accuracy measures. 537 (59%) patients with βTT (299 (56%) women, and 238 (44%) men), and also 370 (41%) patients with IDA (293 (79%) women, and 77 (21%) men) were participated in this study for evaluating the 28 discrimination indices diagnostic performance. Two new introduced indices (CRUISE index and index26) have better performance than some discrimination indices. Indices with the amount of AUC higher than 0.8 had very appropriate diagnostic accuracy in discrimination between βTT and IDA, and also CRUISE index has good diagnostic accuracy, too. The present study was also the first cluster analysis application in order to identify the homogeneous subgroups of different indices with similar diagnostic function. In addition, new indices that offered in this study have presented a relatively closed diagnostic performance by using cluster analysis for the different indices described in earlier studies. Thus, we suggest the using of cluster analysis in order to determine differential indices with similar diagnostic performances.
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Affiliation(s)
- Mina Jahangiri
- Department of Biostatistics and Epidemiology, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Ph.D. Student, Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fakher Rahim
- Research Center of Thalassemia and Hemoglobinopathy, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
- Clinical Research Development Unit, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Amal Saki Malehi
- Department of Biostatistics and Epidemiology, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Research Center of Thalassemia and Hemoglobinopathy, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Lian Y, Shi J, Nie N, Huang Z, Shao Y, Zhang J, Huang J, Li X, Ge M, Jin P, Wang M, Zheng Y. Reticulocyte Hemoglobin Equivalent (Ret-He) Combined with Red Blood Cell Distribution Width Has a Differentially Diagnostic Value for Thalassemias. Hemoglobin 2019; 43:229-235. [PMID: 31476929 DOI: 10.1080/03630269.2019.1655440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As a type of congenital microcytic hypochromic anemia, thalassemia trait is often confused with other conditions, such as congenital sideroblastic anemia (CSA) and iron deficiency anemia, before a specific work-up is performed. However, these tests, including hemoglobin (Hb) electrophoresis, gene mutations and Prussian blue staining after bone marrow aspirate, are relatively expensive, time-consuming and invasive. To find labor-saving parameters to facilitate differential diagnosis, we retrospectively analyzed the routine blood indexes of 59 thalassemia trait cases [22 α-thalassemia (α-thal), 36 β-thalassemia (β-thal) and one α/β-thal], 21 CSA patients, and 238 iron deficiency anemia controls. Significantly higher reticulocyte Hb equivalent (Ret-He) and lower red blood cell (RBC) distribution width (RDW) were prominent in thalassemia trait. Furthermore, RDW-standard deviation (SD) was independent of the severity of anemia in thalassemia trait, similar to Ret-He in CSA. In the context of the same grades of anemia, Ret-He combined with RDW was powerful in differentiation of thalassemia from CSA and iron deficiency anemia. By receiver operation curve (ROC) analysis, Ret-He had a specificity of 67.06% and a sensitivity of 76.92% with a cutoff value of 20.9 pg for thalassemia trait in mild anemia and a specificity of 84.09% and a sensitivity of 68.42% with a cutoff value of 19.1 pg for thalassemia trait in moderate anemia. Regarding CSA, Ret-He had 92.94% specificity and 60.00% sensitivity in mild anemia, with a cutoff value of 18.1 pg. Overall, Ret-He and RDW are two convenient indexes able to differentiate thalassemia from the other two microcytic anemias, CSA and iron deficiency anemia.
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Affiliation(s)
- Yu Lian
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
| | - Jun Shi
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
| | - Neng Nie
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
| | - Zhendong Huang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
| | - Yingqi Shao
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
| | - Jing Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
| | - Jinbo Huang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
| | - Xingxin Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
| | - Meili Ge
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
| | - Peng Jin
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
| | - Min Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
| | - Yizhou Zheng
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin City, People's Republic of China
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Sirdah M, Al Mghari K, Abuzaid AH, Al Haddad RM. Should sex differences be considered when applying mathematical indices and formulas for discriminating β- thalassemia minor from iron deficiency? Pract Lab Med 2018; 11:1-9. [PMID: 30202778 PMCID: PMC6128243 DOI: 10.1016/j.plabm.2018.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/12/2018] [Accepted: 01/30/2018] [Indexed: 12/29/2022] Open
Abstract
Background β-thalassemia minor (BTM) and iron deficiency (ID) are common disorders characterized by microcytosis and/or hypochromasia, leading to a challenge in their discrimination during mass-screening programs especially in developing countries where resources are limited. It has been shown with varying reliability that quick exclusion of either disorder could be achieved mathematically using RBC-based indices and formulas. However, none of these proposed indices and formulas considered the sex-based hematological differences. This comparative retrospective study examined the efficacy of using sex-based RBC indices in the mathematical discrimination BTM and ID in adult males and females. Methods The CBC of randomly selected eight hundred adults diagnosed with BTM or ID (200M & 200F BTM, and 200M & 200F ID) were used in the comparisons. The discrimination power, in terms of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and Youden index were calculated for all subjects and separately for males and females for 20 mathematical indices and formulas. Results Data revealed significant differences in the RBC-based indices between males and females for both BTM and ID groups. Significant variation in reliability indicators for the different indices and formulas were discovered between males and females samples. Conclusion Sex-based indices and formulas are necessary to improve the reliability in mathematically discriminating between BTM and ID in mass screening programs. We also advocate for a large–scale multicenter study to establish the parameters of such indices and formulas with sex and age.
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Affiliation(s)
- Mahmoud Sirdah
- Department of Biology, Al Azhar University-Gaza (AUG), P O Box 1277, Gaza, Palestine
| | | | - Ali H Abuzaid
- Department of Mathematics, Al Azhar University-Gaza (AUG), Gaza, Palestine
| | - Rami M Al Haddad
- Thalassemia and Hemophilia Center, Palestine Avenir Foundation, Gaza, Palestine
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Jameel T, Baig M, Ahmed I, Hussain MB, Alkhamaly MBD. Differentiation of beta thalassemia trait from iron deficiency anemia by hematological indices. Pak J Med Sci 2017; 33:665-669. [PMID: 28811791 PMCID: PMC5510123 DOI: 10.12669/pjms.333.12098] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objective: We aimed at finding out reliable parameter in the differentiation of iron deficiency anemia (IDA) and beta-thalassemia trait (β-TT) in the adult population subjected to Saudi Arabian Premarital Screening Program. Methods: A total of 620 adults (age range 21-36 years) reported during February 2012 to November 2012. Tests for serum iron and ferritin were carried out in individuals showing low hemoglobin (Hb). All the selected subjects’ samples were subjected to blood morphology, comparison of MCV, RBC count. Red Cell Distribution Width (RDW) was noted from the Coulter Report whereas Red Cell Distribution Width Index (RDWI) value was calculated for all the samples. Results: A total of one hundred &thirty-five individuals with hypochromic microcytic anemia having normal hemoglobin F and hemoglobin A2 < 3.2% were inducted in the study. Ninety-three were diagnosed having IDA, whereas thirty-two were having βTT. Ten individuals revealed other causes of anemia. The RBC count was higher, and MCV was much lower in βTT as compared to IDA. Both groups were subjected to RDW and RDWI, however, RDWI which showed better sensitivity and specificity for βTT. Conclusion: RDWI is a reliable and useful index for differentiation among IDA and βTT, as compared to RDW.
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Affiliation(s)
- Tahir Jameel
- Prof. Tahir Jameel, FCPS. Professor of Clinical Hematology, Faculty of Medicine, Rabigh, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Mukhtiar Baig
- Prof. Mukhtiar Baig, PhD. Professor of Clinical Biochemistry, Faculty of Medicine, Rabigh, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Ijaz Ahmed
- Dr. Ijaz Ahmed, MPhil. Chief Pathologist, Department of Pathology, King Khalid General Hospital, Hafar Al Batin, Saudi Arabia
| | - Muhammad Barakat Hussain
- Dr. Muhammad Barakat Hussain, PhD. Assistant Professor of Microbiology, Faculty of Medicine, Rabigh, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Motlag Bin Doghaim Alkhamaly
- Dr. Motlag bin Doghaim Alkhamaly, MBA Head of Department, Department of Pathology, King Khalid General Hospital, Hafar Al Batin, Saudi Arabia
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Akkermans MD, Uijterschout L, Vloemans J, Teunisse PP, Hudig F, Bubbers S, Verbruggen S, Veldhorst M, de Leeuw TG, van Goudoever JB, Brus F. Red Blood Cell Distribution Width and the Platelet Count in Iron-deficient Children Aged 0.5-3 Years. Pediatr Hematol Oncol 2016; 32:624-32. [PMID: 26558306 DOI: 10.3109/08880018.2015.1085935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early detection of iron deficiency (ID) and iron deficiency anemia (IDA) in young children is important to prevent impaired neurodevelopment. Unfortunately, many biomarkers of ID are influenced by infection, thus limiting their usefulness. The aim of this study was to investigate the value of red blood cell distribution width (RDW) and the platelet count for detecting ID(A) among otherwise healthy children. A multicenter prospective observational study was conducted in the Netherlands to investigate the prevalence of ID(A) in 400 healthy children aged 0.5-3 years. ID was defined as serum ferritin (SF) <12 μg/L in the absence of infection (C-reactive protein [CRP] <5 mg/L) and IDA as hemoglobin <110 g/L combined with ID. RDW (%) and the platelet count were determined in the complete blood cell count. RDW was inversely correlated with SF and not associated with CRP. Calculated cutoff values for RDW to detect ID and IDA gave a relatively low sensitivity (53.1% and 57.1%, respectively) and specificity (64.7% and 69.9%, respectively). Anemic children with a RDW >14.3% had a 2.7 higher odds (95% confidence interval [CI]: 1.2-6.3) to be iron deficient, compared with anemic children with a RDW <14.3%. The platelet count showed a large range in both ID and non-ID children. In conclusion, RDW can be helpful for identifying ID as the cause of anemia in 0.5- to 3-year-old children, but not as primary biomarker of ID(A). RDW values are not influenced by the presence of infection. There appears to be no role for the platelet count in diagnosing ID(A) in this group of children.
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Affiliation(s)
- M D Akkermans
- a Department of Paediatrics , Juliana Children's Hospital/Haga Teaching Hospital , The Hague , The Netherlands
| | - L Uijterschout
- a Department of Paediatrics , Juliana Children's Hospital/Haga Teaching Hospital , The Hague , The Netherlands
| | - J Vloemans
- a Department of Paediatrics , Juliana Children's Hospital/Haga Teaching Hospital , The Hague , The Netherlands
| | - P P Teunisse
- a Department of Paediatrics , Juliana Children's Hospital/Haga Teaching Hospital , The Hague , The Netherlands
| | - F Hudig
- b Department of Clinical Chemistry , LabWest, Juliana Children's Hospital/Haga Teaching Hospital , The Hague , The Netherlands
| | - S Bubbers
- c Department of Anesthesiology , Juliana Children's Hospital/Haga Teaching Hospital , The Hague , The Netherlands
| | - S Verbruggen
- d Department of Paediatrics , Sophia Children's Hospital/Erasmus Medical Center , Rotterdam , The Netherlands
| | - M Veldhorst
- e Department of Paediatrics , VU University Medical Center , Amsterdam , The Netherlands
| | - T G de Leeuw
- f Department of Anesthesiology , Sophia Children's Hospital/Erasmus Medical Center , Rotterdam , The Netherlands
| | - J B van Goudoever
- e Department of Paediatrics , VU University Medical Center , Amsterdam , The Netherlands.,g Department of Paediatrics , Emma Children's Hospital-Academic Medical Center , Amsterdam , The Netherlands
| | - F Brus
- a Department of Paediatrics , Juliana Children's Hospital/Haga Teaching Hospital , The Hague , The Netherlands
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11
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Chandra H, Shrivastava V, Chandra S, Rawat A, Nautiyal R. Evaluation of Platelet and Red Blood Cell Parameters with Proposal of Modified Score as Discriminating Guide for Iron Deficiency Anemia and β-Thalassemia Minor. J Clin Diagn Res 2016; 10:EC31-4. [PMID: 27437228 DOI: 10.7860/jcdr/2016/17672.7843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/19/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Iron Deficiency Anaemia (IDA) and β-Thalassaemia Minor (BTM) are considered to be important cause of microcytic hypochromic anaemia. Studies have evaluated various red cell parameters which are easily available on electronic cell counters for discrimination of IDA and BTM in different ethnic populations. The analysis of previously established red cell discriminative indices with new cut-off have also been done by studies which may be relevant in their set of population for differentiation. AIM The study was conducted to propose a modified score considering the established red blood cell indices with a new cut off and to formulate index taking into consideration Red Blood Cell (RBC) and platelet parameters for early differentiation of IDA and BTM. MATERIALS AND METHODS The prospective study included cases with MCV< 80 fl and new modified score of 11 was proposed by statistically analysing the previous discriminative indices with new cut-off by giving score 0 for IDA and score 1 for BTM. The summation of all scores gave modified 11 T score. A new cut off for differentiation of IDA and BTM was proposed in the study by using ROC curve and analysing AUC which statistically corresponded to highest accuracy. An attempt to formulate a new index using the RBC and platelet parameters was also made for initial discrimination. RESULTS The study included 153 cases and in addition to red blood cell parameters, mean platelet volume and platelet distribution width also showed statistical significant difference between IDA and BTM (p<0.05). Modified new 11 T score was 87.6% specific for BTM while proposed index showed 80.4% negative predictive value for BTM and correctly identified 75% of cases. CONCLUSION The proposed new index and modified 11T score may be used for initial discrimination of BTM and IDA especially in resource limited regions. Apart from RBC parameters, mean platelet volume and platelet distribution width may also be useful in early differentiation. It is essential to determine cut off of every index in given population for differentiation of these two conditions.
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Affiliation(s)
- Harish Chandra
- Professor, Department of Pathology, Himalayan Institute of Medical Sciences , Dehradun, Uttarakhand, India
| | - Vikas Shrivastava
- Assistant Professor, Department of Pathology, Himalayan Institute of Medical Sciences , Dehradun, Uttarakhand, India
| | - Smita Chandra
- Associate Professor, Department of Pathology, Himalayan Institute of Medical Sciences , Dehradun, Uttarakhand, India
| | - Anil Rawat
- Associate Professor, Department of Pediatrics, Himalayan Institute of Medical Sciences , Dehradun, Uttarakhand, India
| | - Ruchira Nautiyal
- Associate Professor, Department of Obstetrics and Gynaecology, Himalayan Institute of Medical Sciences , Dehradun, Uttarakhand, India
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Huang TC, Wu YY, Chen YG, Lai SW, Wu SC, Ye RH, Lu CS, Chen JH. Discrimination index of microcytic anemia in young soldiers: a single institutional analysis. PLoS One 2015; 10:e0114061. [PMID: 25679510 PMCID: PMC4332505 DOI: 10.1371/journal.pone.0114061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/03/2014] [Indexed: 11/18/2022] Open
Abstract
Background The common differential diagnosis of microcytic anemia in young Asian men includes iron deficiency anemia (IDA), α-thalassemia (αT) and β-thalassemia (βT). In this study, we aimed to distinguish between these diseases in a distinct population of young men using a specific index. Patients and Methods We retrospectively reviewed the laboratory data of young men with microcytic anemia. The clinical, characteristic and laboratory data, including complete blood cell counts, serum ferritin and hemoglobin electrophoresis results, were collected; genomic DNA mutations were also evaluated. Based on these data, ten discrimination indices were used to differentiate thalassemia from IDA. The sensitivity, specificity, positive and negative predictive values, Youden’s index and receiver operating characteristic (ROC) curves were also calculated. Results A total of 877 patients (92 patients with IDA, 332 with αT and 453 with βT) were enrolled; the Shine and Lal (S&L) formula was the best method with which to discriminate IDA from thalassemia (100% sensitivity, 91% specificity). The new cut-off values were evaluated, and the approaches used in our study cohort, particularly the Green & King (G&K) formula, significantly increased the accuracies of red cell distribution width-containing indices (cut-off value: 58.66; 89.62% sensitivity and 96.2% specificity; AUC: 0.9716). In addition, when applied properly, these indices could differentiate IDA patients from αT patients, especially Huber-Herklotz index (HH). Conclusions The sensitivity and specificity differed among ethnic and age groups. We concluded that when using the original cut-off value, the S&L formula was the best discriminating index for differentiating between IDA and thalassemia in young Asian men. However, when using the G&K formula, the newly obtained cut-off value must be applied to increase accuracy based on the results from our cohort.
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Affiliation(s)
- Tzu-Chuan Huang
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Yi-Ying Wu
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Guang Chen
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Shiue-Wei Lai
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Sheng-Cheng Wu
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Ren-Hua Ye
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Chieh-Sheng Lu
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Jia-Hong Chen
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Hoffmann JJ, Urrechaga E, Aguirre U. Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia: a meta-analysis. ACTA ACUST UNITED AC 2015; 53:1883-94. [DOI: 10.1515/cclm-2015-0179] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/01/2015] [Indexed: 11/15/2022]
Abstract
AbstractMore than 40 mathematical indices have been proposed in the hematological literature for discriminating between iron deficiency anemia and thalassemia trait in subjects with microcytic red blood cells (RBCs). None of these discriminant indices is 100% sensitive and specific and also the ranking of the discriminant indices is not consistent. Therefore, we decided to conduct the first meta-analysis of the most frequently used discriminant indices.An extensive literature search yielded 99 articles dealing with 12 indices that were investigated five or more times. For each discriminant index we calculated the diagnostic odds ratio (DOR) and summary ROC analysis was done for comparing the performance of the indices.The ratio of microcytic to hypochromic RBCs (M/H ratio) showed the best performance, DOR=100.8. This was significantly higher than that of all other indices investigated. The RBC index scored second (DOR=47.0), closely followed by the Sirdah index (DOR=46.7) and the Ehsani index (DOR=44.7). Subsequently, there was a group of four indices with intermediate and three with lower DOR. The lowest performance (DOR=6.8) was found for the RDW (Bessman index). Overall, the indices performed better for adults than for children.The M/H ratio outperformed all other discriminant indices for discriminating between iron deficiency anemia and thalassemia trait. Although its sensitivity and specificity are not high enough for making a definitive diagnosis, it is certainly of value for identifying those subjects with microcytic RBC in whom diagnostic tests for confirming thalassemia are indicated.
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Bock F, Borucki K, Vorwerk P, Biemann R, Isermann B. A two-and-a-half-year-old breastfed toddler presenting with anemia: a case report. BMC Res Notes 2014; 7:917. [PMID: 25514884 PMCID: PMC4300836 DOI: 10.1186/1756-0500-7-917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anemia is a common presentation in children but the differential diagnosis of iron deficiency and β-thalassemia remains a diagnostic challenge. Red blood cell indices have been shown to perform weakly in such scenarios. One potential cause is breastfeeding, but the evidence for unusually prolonged exclusive breastfeeding as a cause of iron deficiency anemia in older (>2 years) toddlers is sparse and the association of breastfeeding with iron deficiency in this age group of older toddlers is not unequivocally established. In this case we describe an unusual cause of nutritional iron deficiency anemia in the age group of 2-3 years. CASE PRESENTATION We describe a two-and-a-half-year-old Turkish boy who presented to our outpatient clinic with recurrent diarrhea and anemia. The patient was febrile (99.1°F) with pale skin and signs of mild dehydration. A reduced nutritional status with a weight of 11.5 kg between the 3rd and 10th percentile was noted. Nutritional evaluation revealed that the boy was still exclusively breastfed with more than 6 times breastfeedings per day. Iron supplementation ameliorated the anemia and reduced hypochromic red blood cells. CONCLUSION The case demonstrates that unusually prolonged (longer than two years) exclusive breastfeeding is a potential cause of iron deficiency anemia in older toddlers. We discuss a simple combination of laboratory tests with ferritin and red cell distribution width that together with a nutritional evaluation provide a quick diagnosis and show that even at such an advanced stage of nutritional iron deficiency oral iron supplementation is an effective treatment.
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Affiliation(s)
| | | | | | | | - Berend Isermann
- Department of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany.
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