Document Type : original article
Author
1. Department of Hematology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran. 2. Pediatric growth and development research center, Institute of Endocrinology and metabolism Iran University of Medical Sciences, Tehran, Iran
Abstract
Background: Iron Deficiency Anemia (IDA) is a massive health concern with a high frequency in Iran. Differentiating between IDA and other microcytic-hypochromic anemia like beta thalassemia minor requires demanding and money consuming tests. That is why this study aimed to assess well-suited and conclusive deferential indexes for IDA diagnosis among children aged between 1-15 years old
Methods: Blood samples were collected from outpatients aged between 1-15 years old. Consequently, Ferritin, Hemoglobin, Serum Iron, RBC count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), red cell volume distribution width (RDW), total iron binding capacity (TIBC) were determined. Furthermore, differential indexes including Mentzer, Shine and Lal and England-Frazer were measured and the data were analyzed using SPSS.
Results: Out of 100 children, 72 individuals were healthy and 28 had IDA. The average age was 3.6±2.9 years. The prediction value of the RBC indexes for the differentiation IDA were as follows: MCV (99%), HB (96%), Ferritin (95%), HCT (87%), MCH (79%), Serum Iron (71%), RBC count (51%), RDW (27%), and TIBC (26%). The prediction values of the formulas were as follows: Shine and Lal (96%), Mentzer (80%), and England-Frazer (79%).
Conclusion: According to the findings, it is possible to diagnose IDA by Complete Blood Count (CBC) test accompanied by differential indexes. A simple selective index such as Shine and Lal might be very beneficial for screening of IDA. This index is also useful for the diagnosis of microcytic anemia.
Keywords
- Rathod DA, Kaur A, Patel V, Patel K, Kabrawala R, Patel V, Patel M, Shah P. Usefulness of cell counter–based parameters and formulas in detection of β-thalassemia trait in areas of high prevalence. American Journal of Clinical Pathology. 2007; 128(4):585-9.
- McLean E, Cogswell M, Egli I, Wojdyla D, De Benoist B. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993-2005. Public health nutrition. 2009; 12(4):444.
- Daneshian M, Sharafi M, Paknahad A, Paknahad S, Pouraskar M. Thalassemia as the most prevalent blood disorder in Iran. A Review. Journal of Current Research in Science. 2014; 2(6):869.
- Akbari M, Moosazadeh M, Tabrizi R, Khatibi SR, Khodadost M, Heydari ST, Naghibzadeh Tahami A, Lankarani KB. Estimation of iron deficiency anemia in Iranian children and adolescents: a systematic review and meta-analysis. Hematology. 2017; 22(4):231-9.
- Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, Regan M, Weatherall D, Chou DP, Eisele TP, Flaxman SR, Pullan RL, Brooker SJ, Murray CJL. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014; 123(5):615-24.
- Camaschella C. Iron-deficiency anemia. New England Journal of Medicine. 2015; 372(19):1832-43.
- Origa R. [beta]-Thalassemia. Genetics in Medicine. 2016.
- Thomas C, Thomas L. Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Clinical chemistry. 2002; 48(7):1066-76.
- Mentzer W. Differentiation of iron deficiency from thalassaemia trait. The Lancet. 1973; 301(7808):882.
- Shine I, Lal S. A strategy to detect β-thalassaemia minor. The Lancet. 1977; 309(8013):692-4.
- England J, Fraser P. Differentiation of iron deficiency from thalassaemia trait by routine blood-count. The Lancet. 1973; 301(7801):449-52.
- Vehapoglu A, Ozgurhan G, Demir AD, Uzuner S, Nursoy MA, Turkmen S, Kacan A. Hematological indices for differential diagnosis of beta thalassemia trait and iron deficiency anemia. Anemia. 2014; 2014.
- 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. Scientific Reports. 2019; 9: 1-13.
- Archer NM, Brugnara C. Diagnosis of iron-deficient states. Critical reviews in clinical laboratory sciences. 2015; 52(5):256-72.
- Melo MR, Purini MC, Cancado RD, Kooro F, Chiattone CS. The use of erythrocyte (RBC) indices in the differential diagnosis of microcytic anemias: is it an approach to be adopted? Revista da Associacao Medica Brasileira (1992). 2001; 48(3):222-4.
- Qurtom H, Al-Saleh Q, Lubani M, Hassanein A, Kaddoorah N, Qurtom M, al-Sheikh T. The value of red cell distribution width in the diagnosis of anaemia in children. European journal of pediatrics. 1989; 148(8):745-8.
- Rashwan NI, Ahmed AE-A, Hassan MH, Mohammed ME, Bakri AH. Hematological indices in differentiation between iron deficiency anemia and beta-thalassemia trait. International Journal of Pediatrics. 2022; 10(1):15285-95.
- Maskoen AM, Reniarti L, Sahiratmadja E, Sisca J, Effendi SH. Shine & Lal index as a predictor for early detection of β-thalassemia carriers in a limited resource area in Bandung, Indonesia. BMC Medical Genetics. 2019; 20(136):1-6.
- Mustafa A, Ali BA, Zulfiqar M, Naseem L. Role of Discrimination Indices in Screening of Beta Thalassemia Trait inLow-Resourced Areas of Pakistan. National Journal of Health Sciences. 2019; 4:21-4.
)