index [11], mean density of hemoglobin per liter of blood (MDHL), mean cell hemoglobin density (MCHD) [12], and RBC count were evaluated and compared. In this study, we compared the ability of different 12 indices to distinguish β-TT from IDA by calculating their sensitivity, specificity, and Youden’s index values. Red cell values at various ages of study groups and mean and lower limit of normal (−2 SD). Aysel Vehapoglu, Gamze Ozgurhan, Ayşegul Dogan Demir, Selcuk Uzuner, Mustafa Atilla Nursoy, Serdar Turkmen, Arzu Kacan, "Hematological Indices for Differential Diagnosis of Beta Thalassemia Trait and Iron Deficiency Anemia", Anemia, vol. In the present study, Shine and Lal index demonstrated highest sensitivity (98.4%). In the 290 children with microcytic anemia, 186 children (64.1%) had a high RBC count (RBC count > 5.0 × 106/μL) at the time of diagnosis. According to Youden’s index, the Shine and Lal index and RBC count showed the greatest diagnostic value in patients < 10 years (89% and 82%, resp.). Background. BibTeX index > Shine and Lal index > MCHD. Mentzer Index sensitivity (Sn) was 0.36 with specificity (Sp) at 0.81, positive predictive value (PPV) at 0.44 and negative predictive value (NPV) at 0.75. It has been estimated that 30% of the global population suffers from iron deficiency anemia (IDA), and most of those affected live in the developing countries. Rahim and Keikhaei examined the diagnostic accuracy of 10 indices in 153 patients with β-TT and 170 patients with IDA. In 2009, Ehsani et al. They found that the Mentzer index had 85% sensitivity, 93% specificity, and 79% Youden’s index [20]. We are committed to sharing findings related to COVID-19 as quickly as possible. This site uses cookies. 1st International Conference on Life and Applied Sciences for Sustainable Rural Development 14–16 November 2018, Purwokerto, Central Java, Indonesia [2]. The combined cases were excluded from the early stages of the evaluation study. IOP Conference Series: Earth and Environmental Science, An ideal discrimination index has high sensitivity and specificity; that is, it can detect the maximum number of patients with β-TT (high sensitivity) while eliminating patients with IDA (high specificity). Therefore, none of the subjects in the present study had both IDA and β-TT. and the Shine and Lal indices demonstrated the highest sensitivity (100%) but had low specificities for correctly identifying IDA (14.7%) and β-TT (10.2%). Youden’s index considers both sensitivity and specificity and provides an appropriate measure of validity for a particular question or technique. You do not need to reset your password if you login via Athens or an Institutional login. demonstrated that RDWI had the highest sensitivity (78.9%), that the England and Fraser index had the highest specificity and highest Youden’s index (99.1 and 64.2%, resp. The authors declare that there is no conflict of interests regarding the publication of this paper. In 2007, Ntaios et al. Hematological and biochemical date of study groups. Diagnoses associated with Mentzer index and the sensitivity and specificity for each. Mentzer index could be used to predict the diagnosis of beta-thalassemia carrier. An independent sample -test was performed to detect differences between the two groups of anemic children. According to our results, the percentage of correctly diagnosed patients was the highest with the Mentzer index (91%) followed by the Ehsani et al. All children with IDA received oral iron for 16 weeks, and HbA2 screening was performed after iron therapy. Mentzer index OR value was 2.4 (0.5 - 11.5, CI95%). Methods. Red cell values at various ages of study groups are shown in Table 5. index (84.8%). compared nine discriminant functions in patients with microcytic anemia and measured validity using Youden’s index. To find out more, see our, Browse more than 100 science journal titles, Read the very best research published in IOP journals, Read open access proceedings from science conferences worldwide, Published under licence by IOP Publishing Ltd, IOP Conference Series: Earth and Environmental Science. Patients with β-TT and concomitant iron deficiency may show normal HbA2 levels. Mentzer index could be used to predict the diagnosis of beta-thalassemia carrier. MCV was 60.11 ± 3.49 and MCHD was 18.9 ± 1.37 in the β-TT group, and these values were lower than those in the IDA group (67.49 ± 7.14 and 21.3 ± 3.09, respectively; ). The study resulted in 60.5% sensitivity, 28.6% specificity, 82.1%, positive predictive value, 11.8%, negative predictive value, 0.9 positive likelihood ratio, and 11.8%, negative likelihood ratio for MI in diagnosing IDA. As indicated in Table 4, none of the indices studied demonstrated 100% precision in recognizing β-TT. If you have a user account, you will need to reset your password the next time you login. They found Mentzer index to be the best formula with a sensitivity of 85.41% and specificity of 81.75%. S&L had 87.63% specificity and 93.4% NPV. Mentzer Index sensitivity (Sn) was 0.36 with specificity (Sp) at 0.81, positive predictive value (PPV) at 0.44 and negative predictive value (NPV) at 0.75. HbA2 screening was performed after completion of the 16-week iron replacement regimen. The difference between the results of all of these indices and the gold standard (HbA2) was significant (). index (sensitivity + specificity– 100) for each of these indices to diagnose IDA, which, by taking into account both sensitivity and specificity,measures their validity to diagnose IDA versus AT. In their study, the Mentzer and Ehsani et al. It may be that interpopulation differences in the effectiveness of various RBC indices for discriminating β-TT from IDA could be attributed to differences in the mutation spectrum of the thalassemia disease in different populations [22]. It is also important to note that the test has a high sensitivity and low specificity. We found that with the new criterion, MI had the highest sensitivity and negative predictive value (NPV) with 85.41% and 95.3% respectively. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Ehsani et al. In conclusion, the cell-count-based indices, particularly the Mentzer index, are easily available and reliable methods for detecting β-TT. The diagnosis of β-TT involves measuring the HbA2 concentration of lysed RBCs via HPLC. You will only need to do this once. The third highest one was RBC count (83.4%). Those are shown in Table 1. Sci. The number of correctly identified cases were determined, sensitivity, specificity, positive and negative predictive value and Youden’s index (YI) of each discrimination index was calculated. Thalassemia diagnosis requires gen examination using Polymerase Chain Reaction (PCR) device or hemoglobin (Hb) electrophoresis using electrophoresis or High Performance Liquid Chromatography (HPLC) device which is only available in certain hospitals. index [10]. However, the frequency of high RBC count was 29.4% in children with IDA. Therefore, it is important to develop easily examined parameters which are useful to assess thalassemia carrier diagnosis. The England and Fraser and the Shine and Lal indices had the lowest Youden’s index values of 51.4% and 10.2%, respectively. Similar results (Mentzer index: sensitivity, 90.9%; specificity, 80.3%) were found by Ghafouri et al. The highest sensitivity was noted by the Shine and Lal index (88.16%). Conclusion. G&K proved to be the most reliable index, as it had the highest sensitivity (75.06%), efficiency (80.12%), and Youden's index (70.86%) for the detection of β-TT. Mentzer Index sensitivity (Sn) was 0.36 with specificity (Sp) at 0.81, positive predictive value (PPV) at 0.44 and negative predictive value (NPV) at 0.75. The two most frequent types of microcytic anemia are beta thalassemia trait (β-TT) and iron deficiency anemia (IDA). The IDA group consisted of children with Hb levels of 8.7–11.4 g/dL, mean corpuscular volume (MCV) < 80 fL at age > 6 years or MCV < 70 fL at age < 6 years, serum iron level < 30 μg/dL, transferrin saturation < 16%, and serum ferritin level ≤ 12 ng/dL. Results obtained from each discrimination index and correctly identified number of the children. Transferrin saturation was calculated as the ratio of SI to TIBC. Signed informed consent was obtained from the parents of study subjects. Individuals with the beta thalassemia trait (β-TT) are usually asymptomatic and may be unaware of their carrier status unless diagnosed by testing. [19]. According to our results, the percentage of corr… Export citation and abstract SI and total iron binding capacity (TIBC) were determined calorimetrically (Siemens Advia 2400 Chemistry Analyzer), and ferritin was measured by immunoassay using a Siemens Advia XP Analyzer. Copyright © 2014 Aysel Vehapoglu et al. Iron deficiency modulates HbA2 synthesis, resulting in reduced HbA2 levels in patients with IDA [13, 14]. The Mentzer index was the most reliable index, as it had the highest sensitivity (98.7%), specificity (82.3%), and Youden’s index (81%) for detecting β-TT; this was followed by the Ehsani index (94.8%, 73.5%, and 68.3%, resp.) Mentzer Index sensitivity (Sn) was 0.36 with specificity (Sp) at 0.81, positive predictive value (PPV) at 0.44 and negative predictive value (NPV) at 0.75. Distinguishing β-TT from IDA has important clinical implications because each disease has an entirely different cause, prognosis, and treatment. Our data (Table 1) showed significant differences between the hematological and biochemical parameters of β-TT and IDA children except for Hb and RDW, but these differences were not reflected in the indices’ reliability in differential diagnosis of β-TT and IDA. By continuing to use this site you agree to our use of cookies. Keywords: Mentzer Index, diagnostic value, thalassemia 1. The highest specificity was noted by the Mentzer index (88.0%). index (85.5%). None of the subjects had a combined case of IDA and β-TT. values < 0.05 were considered significant. Youden's index is the most reliable method by which to measure the validity of a particular technique, because it takes into account both sensitivity and specificity. Mentzer index OR value was 2.4 (0.5 - 11.5, CI95%). The percentage of correctly diagnosed cases was the highest for Red Cell Distribution Width Index (RDWI) (84.19%) followed by Mentzer Index (86.85%). Statistical analysis of data was done by SPSS 16 software. The β-TT group consisted of children with Hb levels of 9–11.46 g/dL, mean corpuscular volume (MCV) < 80 fL at age > 6 years or MCV < 70 fL at age < 6 years, serum iron level > 30 μg/dL, transferrin saturation > 16%, serum ferritin level > 12 ng/dL, and HbA2 > 3.5%. A similar result for the Green and King index (Youden’s index, 80.9%) was found by Urrechaga et al. 34 studied 135 cases of BTT and 81 The samples were obtained during the course of routine analysis and collected in EDTA anticoagulant tubes. Methods. The England and Fraser and the Mentzer indices demonstrated the highest specificities at 85.3% and 82.3%, respectively. W Siswandari1, L Rujito1, V Indriani1 and W Djatmiko1, Published under licence by IOP Publishing Ltd Introduction: Thalassemia is in the differential diagnosis of a microcytic anemia. E&F had highest specificity with 95.63% but lowest sensitivity of 40%. When the Mentzer index was calculated, 264 children with microcytic anemia (91%) were correctly diagnosed. Youden index which tells about the overall performance of a diagnostic test was highest for Kerman 1 index (65.4%). It seems that RBC alone was not a reliable tool for distinguishing β-TT from IDA. Children with Hb levels < 8.7 g/dL were excluded because these cases of severe anemia are not confused with β-TT in daily practice. The positive and negative predictive values of Mentzer index in diagnosing β-TT were 36.6% and 100%, respectively. We calculated 12 discrimination indices in all patients with hemoglobin (Hb) values of 8.7–11.4 g/dL. Conclusion: The diagnostic value order of the indices , in terms of sensitivity and specificity was as Kerman> Mentzer> Serivastava. indices were able to correctly diagnose 94.7% and 92.9% of cases, respectively, and both are easy to calculate [11]. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Youden’s index of twelve indices to discriminate between. 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Signed informed consent was obtained from the early stages of the children fast-track new submissions % in children microcytic. The newly found index- RDW University, Turkey disease has an entirely different cause, prognosis and.

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