Role of Haemogram Parameters and RBC Indices in Screening and Diagnosis of Beta-Thalassemia Trait in Microcytic, Hypochromic Indian Children

Nikita Tripathi^1, , Jai Prakash Soni², Pranav Kumar Sharma³ and Manish Verma⁴

¹Dr. S.N MedicalCollege, Jodhpur, R.U.H.S, India

²Dr. S.N Medical College, Jodhpur

³Department of Cardiology, Apollo Group of Hospitals, Delhi, India

⁴Department of Paediatrics, Dr. S.N Medical College, Jodhpur, India

Cite this paper:
Nikita Tripathi, Jai Prakash Soni, Pranav Kumar Sharma and Manish Verma. Role of Haemogram Parameters and RBC Indices in Screening and Diagnosis of Beta-Thalassemia Trait in Microcytic, Hypochromic Indian Children. International Journal of Hematological Disorders. 2015; 2(2):43-46. doi: 10.12691/ijhd-2-2-4

Abstract

AIM: To assess the validity and discrimination power of haemogram parameters and RBC indices in diagnosing βTT in microcytic, hypochromic anaemia. MATERIAL AND METHODS: A prospective study was conducted on the microcytic, hypochromic anaemic OPD and indoor admitted patients in Umaid Hospital, Jodhpur measured with electronic cell counter (Sysmex K800). HbA2 was calculated on the cohort by the Hb variant [Bio-Rad, USA] system by using the HPLC technique. The Hb, MCV, MCH, TRBC and four RBC indices ,Mentzer, Srivastava, Shine and Lal and England and Frazer were assessed for the positives on the basis of their individual ROC cut offs obtained in the study. RESULTS: Out of 848 microcytic, hypochromic anaemic patients, 185 were diagnosed thalassemia minor. The various haemogram parameters and RBC indices were then analysed . CONCLUSION: MCV≤59.9 fL and Mentzer Index≤12.45 were the best discriminating indices obtained with high sensitivity, NPV, YI and ARUC. No test or parameter though, had a 100 % sensitivity or specificity.

Keywords:
βTT haemogram RBC INDICES YI ROC

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References:

[1]	Madan N, Sharma S, Sood SK, Colah R, Bhatia LHIndian J Hum Genet. 2010 Jan; 16(1):16-25.
[2]	Rathod A, Kaur A, Patel V, et al. Usefulness of cell counter-based parameters and formulas in detection of β-thalassemia trait in areas of high prevalence. Am J Clin Pathol 2007; 128:585-589.
[3]	PRB. World population data sheet. Population Reference Bureau, Washington DC 2010.
[4]	Mahendra Singh, Anuradha Gautam. To Evaluate Anaemia by Erythrocyte Indices, Red Cell Distribution width and Haemoglobin Electrophoresis with Special Reference to Thalassemia in Paediatric Age Group. Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 11, February 05; Page: 1755-1764.
[5]	Yasar M. Yousafzai, Shahtaj Khan, Fazle Raziq Department of Haematology and Transfusion Medicine, Hayatabad Medical Complex, Peshawar, Pakistanβ-thalassaemia trait: haematological parameters;J Ayub Med Coll Abbottabad 2010;22(4).
[6]	Claude Owen Burdick; Separating Thalassemia Trait and Iron Deficiency by Simple Inspection; Am J Clin Pathol 2009; 131: 444-445.
[7]	Amrish N. Pandya, Manik Agarwal, Deepshikha Dave. “Red Cell Distribution Width as a Screening Tool in Classifying Microcytic Hypochromic Anemias”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 23, June 09; Page: 6559-6565.
[8]	J Kotwal, renu saxena, v.p.choudhry, s.n.dwivedi, m.bhargava, “Erythrocyte indices for discriminating thalassaemic and non-thalassemic microcytosis in Indians”, The National Medical Journal of India vol. 12, no.6, 1999.
[9]	Mentzer WL. (1973) differentiation of iron deficiency from thalassemia trait Lancet 882 Quoted by Barbara.
[10]	Srivastava PC: Differentiation of thalassemia minor from iron deficiency Lancet 1973; 154-55Quoted by Barbara J. Bain.
[11]	Shine I, Lal S. A strategy to detect b-thalassemia minor: Lancet 1977; 692.
[12]	England JM, Fraser P; Discrimination between iron-deficiency and heterozygous-thalassemia syndromes in differential diagnosis of microcytosis. Lancet 1979; 1:145-8.
[13]	Madeleine Verhovsek, Chi-Chiu So3, Timothy O'Shea, Geoffrey T. Gibney, Edmond S.K. Ma, Martin H. Steinberg1 and David H.K. Chui;Is HbA2 level a reliable diagnostic measurement for β-thalassemia trait in people with iron deficiency; American Journal of Hematology Volume 87, Issue 1, pages 114-116, January 2012
[14]	Bhukhanvala D, Seliya V, Shah A, Gupte S. Study of parents of β-thalassemia major children to determine cutoff values of hematological parameters for diagnosis of β-thalassemia trait and assessment of anemia in them. Indian J Med Sci 2013; 67:117-122.
[15]	Aziz Batebi, Abolghasem Pourreza, Reza Esmailian: Discrimination of beta-thalassemia minor and iron deficiency anemia by screening test for red blood cell indices: Turk J Med Sci2012; 42 (2): 275-280.
[16]	Soliman A.R., Kamal G , Elsalakawy Walaa A., Sallam Mohamed T.H; Blood indices to differentiate between β-thalassemia trait and iron deficiency anemia in adult healthy Egyptian blood donors; 1110-1067 © 2014 The Egyptian Society of Haematology.
[17]	M. M. Eldibany, K. F. Totonchi, N. J. Joseph, and D. Rhone, “Usefulness of certain red blood cell indices in diagnosing and differentiating thalassemia trait from iron-deficiency anaemia,” American Journal of Clinical Pathology, vol. 111, no. 5, pp. 676-682, 1999.
[18]	Chaima Abdelhafidh Sahli , Amina Bibi*, Faida Ouali , Sondess Hadj Fredj, Boutheina Dakhlaoui , Rym Othmani , Naouel Laouini; Red cell indices: differentiation between β -thalassemia trait and iron deficiency anemiaand application to sickle-cell disease andsickle-cell thalassemia; Clin Chem Lab Med 2013.
[19]	Demir A, Yarali N,Fisgin T, Duru F,Kara AR. Most reliable indices in differentiation between thalassemia trait and iron deficiency anaemia. Paedia Int 2002: 44: 612-6.
[20]	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 Haematol 2008; 30: 324-30.
[21]	Shen C, Jiang YM, Shi H, Liu JH, Zhou WJ, Dai QK, Yang Evaluation of indices in differentiation between iron deficiency anemia and beta-thalassemia trait for Chinese children. HJ Pediatr Haematol Oncol. 2010 Aug; 32(6):e218-22.
[22]	Ghafouri M, Motan Sefat L, Sharifi Sh, Gohari LH, Attarchi Z. Comparison of cell counter indices in differentiation of beta thalassemia minor from iron deficiency anaemia. Blood 2006; 2(sup 7): 385-9.
[23]	Ehsani MA, Shahgholi E, Rahiminejad MS,Seighali F, Rashidi A. A new index for discriminationbetween iron deficiency anaemia and beta thalassemia minor: results in 284 patients. Pak J Bio Sci 2009; 12; 473-5.
[24]	Suad MA, Anwar M Al-A, Doa’a A. Validity assessment of nine discriminant functions used for the differentiation between iron deficiency anaemia and thalassemia minor. J Trop Pediatr 2007; 53:93-7.
[25]	S. M. AlFadhli, A. M. Al-Awadhi, and D. AlKhaldi, “Validity assessment of nine discriminant functions used for the differentiation between Iron deficiency anemia and thalassemia minor,” Journal of Tropical Pediatrics, vol. 53, no. 2, pp. 93-97, 2007.