Application of Various RBC Indices to Differentiate Iron Deficiency Anemia and Beta Thalassemia Trait Among Antenatal Women in A Tertiary Care Hospital
Authors/Creators
- 1. Senior Resident, Dept of Pathology, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam
- 2. Associate Professor, Dept of Pathology, Govt Medical College Vizianagaram
- 3. Assistant Professor, Dept of Pathology, Govt Medical College Vizianagaram
- 4. RMO, King George Hospital, Visakhapatnam
- 5. Senior Resident, Dept of Pathology, Govt Medical College Vizianagaram
- 6. Professor & HOD, Dept of Pathology, Govt Medical College Vizianagaram
Description
Introduction: The most frequent causes of microcytic anemia among antenatal women in India are iron deficiency anemia (IDA) and beta thalassemia trait(βTT). Hence it is important to differentiate between both the conditions to avoid unnecessary iron therapy in βTT patients. This study was done to screen antenatal women with β thalassemia trait using formulas derived from various Red cell indices. Aims And Objectives: This study aims to screen all microcytic (MCV<80fl) hypochromic (MCH<27pg) anemia for β thalassemia trait, to differentiate IDA from βTT and confirm the screened cases by HPLC. Also attempt has been made to assess sensitivity and specificity of various indices to identify βTT. Materials And Methods: A cross sectional comparative study was done in 200 antenatal women for a period of 2 years from October 2019 to September 2021 in department of clinical pathology at Tertiary care hospital. Complete blood counts and various red cell indices were evaluated. There are 16 cases of hemoglobinopathies out of which 9 are β thalassemia trait and 184 cases are iron deficiency anemia. Four indices were calculated i.e., the Mentzer index (MI), Srivastava index (SV), Shine and Lal index (SL) and Red cell Distribution Width (RDW) index. These indices were calculated in patients having microcytosis (MCV<80fl) and hypochromia (MCH<27pg) and, all the cases are further subjected to HPLC for confirmation. Results: In the present study the index with highest sensitivity for diagnosing β thalassemia trait was Shine and Lal index (100%) and Mentzer index showed highest specificity with 99.5%. Positive predictive value (PPV) was highest for Mentzer index and Negative predictive value (NPV) was highest for Shine and Lal index. Youden’s index was highest for RDW. In the present study the percentage of correctly identified patients was highest for Mentzer index. Conclusion: It is vital to establish a screening model based on HbA2 levels and red cell indices for the differentiation of β TT from IDA in microcytic hypochromic anemia cases. According to the results of the present study MI and RDW index are considered as the most useful and reliable indices for screening β thalassemia trait, though HPLC confirmation is mandatory.
Abstract (English)
Introduction: The most frequent causes of microcytic anemia among antenatal women in India are iron deficiency anemia (IDA) and beta thalassemia trait(βTT). Hence it is important to differentiate between both the conditions to avoid unnecessary iron therapy in βTT patients. This study was done to screen antenatal women with β thalassemia trait using formulas derived from various Red cell indices. Aims And Objectives: This study aims to screen all microcytic (MCV<80fl) hypochromic (MCH<27pg) anemia for β thalassemia trait, to differentiate IDA from βTT and confirm the screened cases by HPLC. Also attempt has been made to assess sensitivity and specificity of various indices to identify βTT. Materials And Methods: A cross sectional comparative study was done in 200 antenatal women for a period of 2 years from October 2019 to September 2021 in department of clinical pathology at Tertiary care hospital. Complete blood counts and various red cell indices were evaluated. There are 16 cases of hemoglobinopathies out of which 9 are β thalassemia trait and 184 cases are iron deficiency anemia. Four indices were calculated i.e., the Mentzer index (MI), Srivastava index (SV), Shine and Lal index (SL) and Red cell Distribution Width (RDW) index. These indices were calculated in patients having microcytosis (MCV<80fl) and hypochromia (MCH<27pg) and, all the cases are further subjected to HPLC for confirmation. Results: In the present study the index with highest sensitivity for diagnosing β thalassemia trait was Shine and Lal index (100%) and Mentzer index showed highest specificity with 99.5%. Positive predictive value (PPV) was highest for Mentzer index and Negative predictive value (NPV) was highest for Shine and Lal index. Youden’s index was highest for RDW. In the present study the percentage of correctly identified patients was highest for Mentzer index. Conclusion: It is vital to establish a screening model based on HbA2 levels and red cell indices for the differentiation of β TT from IDA in microcytic hypochromic anemia cases. According to the results of the present study MI and RDW index are considered as the most useful and reliable indices for screening β thalassemia trait, though HPLC confirmation is mandatory.
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IJPCR,Vol15,Issue6,Article22.pdf
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Additional details
Dates
- Accepted
-
2023-05-15
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue6,Article22.pdf
- Development Status
- Active
References
- 1. Akai Y. Kubota F. Bichile S. K. Mehta N. B. A Study of beta thalassemia screening using an automated hematology analyser. Symex journal International.1998; 8:2. 2. Khan MI, Khan HN, Usman M. Beta thalassemia trait; diagnostic importance of haematological indices in detecting beta thalassemia trait patients. Professional Med J. 2018; 25(4):545-550. 3. Baliyan M, Kumar M, Nangia A, Parakh N. Can RBC Indices be Used as Screening Test for BetaThalassemia in Indian Antenatal Women J Obstet Gynaecol India. 2019 Dec;69(6):495-500. 4. Madan N, Meera S, Satendra S, Usha Rusia, KusumKela. Red cells Indices and Discriminant functions in the detection of Beta – Thalassemia Trait in a population with High prevalence of Iron Deficiency Anemia. Indian J Pathol Microbiol. 1999; 42 (1): 55-61 5. Lokeshwar M.R. Shah N, Kanakia S, et al, epidemiology in thalassemia, IAP Textbook of pediatrics, 3rd edition 2006. 6. Sarnaik SA. Symposium-Thalassemia and related Hemoglobinopathies. Indian Pediatr. 2005; 72 (4): 319-324. 7. Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela SR. Prospective study on prevalence of anemia of pregnant women and its outcome: A community-based study. J Family Med Prim Care. 2017 OctDec;6(4):739-743 8. Sinha Anuradha, Adhikary Moumita, Phukan Jyoti P., Kedia Sonal, Sinha Tirthankar. A study on anemia and its risk factors among pregnant women attending antenatal clinic of a rural medical college of West Bengal. Journal of Family Medicine and Primary Care. 10(3):1327-1331. 9. Parthasarathy V. A search for Beta thalassemia trait in India. Turk J Haematol. 2012 Dec;29(4):427-9. 10. Galanello R, Origa R. Betathalassemia. Orphanet J Rare Dis. 2010 May 21; 5:11 11. 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 MayJun;33(3):665-669 12. Bhushan R et al. Reliability of different RBC Indices to Differentiate between beta thalassemia trait and iron deficiency Anemia during antenatal screening. World Journal of Pathology 2018; 7:14-20 13. Srivastava PC. Differentiation of thalassemia minor from iron deficiency. Lancet. 1973; 2:154-155. 14. Mondal B., Parvez, M., Rana, M. M., Rehman, L., Zahan R., Pal K. C., & Khan W. A. Status of Red Blood Cell Indices in Iron Deficiency Anemia and β Thalassemia Trait: A Comparitive Study Dhaka Shishu (Children) Hospital Journal, 2021; 37(1):9-14. 15. Tripathi N, Soni JP, Sharma PK, Verma M. Role of Haemogram parameters and RBC indices in screening and diagnosis of BetaThalassemia Trait in microcytic hypochromic Indian Children. Int J Hematol Disorders. 2015; 2(2): 43-46. 16. Demir A, Yarali N, Fisgin,T, Duru F, Kara A, Most reliable indices in differentiation between thalassemia trait and iron deficiency anemia. Pediatr Intern. 2002; 44:222-4.17. M. A. Ehsani, E. Shahgholi, M. S. Rahiminejad, F. Seighali, and A. Rashidi, A new index for discrimination between iron deficiency anemia and beta-thalassemia minor: results in 284 patients, Pakistan Journal of Biological Sciences, 2009; 12(5): 473–475. 18. Mentzer WC. Differentiation of iron deficiency from beta thalassemia trait. Lancet. April 1973;1(7808):2000. 19. Vehapoglu Aysel., Ozgurhan G., Demir A.D., Uzuner S., Nursoy M.A., Turkmen S., & Kacan A. Hematological indices for differential diagnosis of beta thalassemia trait and iron deficiency anemia. Anemia. 2014. 20. Shine I, Lal S. A strategy to detect Alpha thalassemia major. Lancet. 1997; 1:692-694. 21. Sehgal K., Mansukhani P., Dadu T., Irani M., & Khodaiji S. Sehgal index; A new index and its comparison with other complete blood count – based indices for screening of beta thalassemia trait in a tertiary care hospital. Indian Journal of Pathology and Microbiology. 2015; 58(3): 310.