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Clinical Chemistry and Laboratory Medicine (CCLM)

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Volume 51, Issue 11


Red cell indices: differentiation between β-thalassemia trait and iron deficiency anemia and application to sickle-cell disease and sickle-cell thalassemia

Chaima Abdelhafidh Sahli / Amina Bibi / Faida Ouali / Sondess Hadj Fredj / Boutheina Dakhlaoui / Rym Othmani / Naouel Laouini / Latifa Jouini / Fekria Ouenniche / Hajer Siala / Imed Touhami
  • Dynamics of Cardiovascular Incoherencies Research Laboratory, EA 2992, Montpellier 1 University, Montpellier, France
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Mariem Becher / Slaheddine Fattoum / Nour El Houda Toumi / Taieb Messaoud
Published Online: 2013-06-26 | DOI: https://doi.org/10.1515/cclm-2013-0354


Background: In Tunisia, thalassemia and sickle cell disease represent the most prevalent monogenic hemoglobin disorders with 2.21% and 1.89% of carriers, respectively. This study aims to evaluate the diagnosis reliability of a series of red blood cell indices and parameters in differentiation of beta-thalassemia trait (β-TT) from iron deficiency anemia (IDA) and between homozygous sickle cell disease (SS) and sickle cell-thalassemia (ST).

Methods: The study covered 384 patients divided into three groups. The first one is composed of 145 control group, the second consists of 57 β-TT and 52 IDA subjects and the last one with 88 SS and 42 ST patients. We calculated sensitivity, specificity, positive-predictive values, negative-predictive values, percentage of correctly identified patients and Youden’s index for each indice. We also established new cut-off values by receiver operating characteristic curves for each indice. An evaluation study was performed on another population composed of 106 β-TT, 125 IDA, 31 SS and 17 ST patients.

Results: Srivastava Index, mean corpuscular hemoglobin, red blood cell, Mentzer Index (MI) and mean corpuscular hemoglobin concentration show the highest reliability in discriminating β-TT from IDA with new cut-offs slightly different from those described in literature. Ehsani Index, mean corpuscular volume, MI, Shine and Lal Index and Sirdah Index are the most powerful in the differentiation between SS and ST.

Conclusions: The effectiveness and the simplicity of calculation of these indices make them acceptable and easy to use for differential diagnosis.

Keywords: β-thalassemia trait; discrimination indice; iron deficiency anemia; sickle cell disease; sickle cell-thalassemia


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About the article

Corresponding author: Amina Bibi, MD, Biochemistry Laboratory, Children’s Hospital, Bab Saadoun Square, Tunis, Tunisia, Phone: +216 98 414607, Fax: +216 71 566463, E-mail:

Received: 2013-05-13

Accepted: 2013-05-26

Published Online: 2013-06-26

Published in Print: 2013-11-01

Citation Information: Clinical Chemistry and Laboratory Medicine, Volume 51, Issue 11, Pages 2115–2124, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2013-0354.

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