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Discrimination Indices in Differentiation of Iron Deficiency Anemia and Beta-Thalassemia Trait
- Cengiz Beyan, Kürşat Kaptan, Ahmet Ifran (5 February 2008)
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Cengiz Beyan, MD, Prof. Department of Hematology, Gulhane Military Medical Academy, Etlik, 06010, Ankara, Turkey, Kürşat Kaptan, Ahmet Ifran
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Dear Editor, We have read with great interest the study by AlFadhli et al which was published online in your journal (1). In this study, the authors evaluated nine discriminant functions in 153 cases with microcytic anemia to correctly discriminate iron deficiency anemia (IDA) and thalassemia trait (TT). The authors found that England and Fraser index had the highest Youden’s index value (98,2) in correctly differentiating between IDA and TT. In discussion, they expressed that in a study done by Demir et al (2), it was reported that red blood cell (RBC) count and red blood cell distribution width (RDW) index (RDWI) are the most reliable discrimination indices in differentiating between IDA and beta-TT. Investigators attributed the difference between these studies to Demir et al’s study was performed with a relatively small group and/or in pediatric population while their study was performed with cases over age sixteen. When we have examined the differences between these groups, we noticed that Demir et al’s study was consisted of 26 IDA and 37 beta-TT cases while this study consisted of only 56 IDA and 47 beta-TT cases (50 cases were beta-TT). The second difference emphasized between these studies was the inclusion of adult population in this study; although they did not reported mean age, standart deviation and ranges of the patients in the study. Our study which was similar to these reports and performed with adult population was presented in 32nd National Congress of Turkish Society of Hematology (3) and was accepted for publication (4). Our study was performed in 45 IDA cases, 36 women and 9 men, whose mean age is 33,87 ± 11,59 (mean ± SD) (17 -57 years) and 66 beta-TT cases, 41 women and 25 men, whose mean age is 33,26 ± 13,36 (mean ± SD) (14-74 years). IDA cases with hemoglobin value <8,7 g/dl have been excluded because these cases are not confused with beta-TT cases in practice. Patient groups have been evaluated according to RBC, RDW, Mentzer index, Shine and Lal index, England and Fraser index, Srivastava index, Green and King index, RDWI and Ricerca index. None of these different formulations are superior to RBC value obtained from automated analyzers in adult cases with IDA and beta-TT. Although RBC value has been found to be more predictive than all of other indices, its power of Youden’s index was only 73,7. When we evaluate our study along with Demir et al’s which was performed in our country, it is possible that the difference between our studies and AlFadhli et al’s has originated from the differences between study populations. Another factor which might explain the difference was the exclusion of cases with hemoglobin value <8,7 g/dl in our studies while AlFadhli et al have included also the cases with hemoglobin value <8,7 g/dl in their study. Finally, we suppose that total body iron status and hemoglobin A2 level should be obtained for accurate differential diagnosis of IDA and beta-TT until more efficient tools develop. Sincerely, References 1.AlFadhli SM, Al-Awadhi AM, AlKhaldi D. Validity assessment of nine discriminant functions used for the differentiation between iron deficiency anemia and thalassemia minor. J Trop Pediatr (in press). 2.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;44:612-6. 3.Beyan C, Kaptan K, Ifran A. Predictive value of discrimination indices in differential diagnosis of iron deficiency anemia and beta-thalassemia trait. Congress Abstract of 32nd National Congress of Turkish Society of Hematology, poster no. P0085. Turk J Hematol 2006;23(Suppl.1):125(abstract). 4.Beyan C, Kaptan K, Ifran A. Predictive value of discrimination indices in differential diagnosis of iron deficiency anemia and beta-thalassemia trait. Eur J Haematol (in press). Conflict of Interest:None declared |
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