Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

12 Issues per year


IMPACT FACTOR 2016: 3.432

CiteScore 2017: 2.34

SCImago Journal Rank (SJR) 2017: 1.114
Source Normalized Impact per Paper (SNIP) 2017: 1.188

Online
ISSN
1437-4331
See all formats and pricing
More options …
Volume 51, Issue 11

Issues

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

Abstract

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

References

  • 1.

    Fattoum S. Evolution of hemoglobinopathy in Africa: results, problems and prospect. Medit J Hemat Infect Dis 2009:1.Google Scholar

  • 2.

    Nobili B, Silverio P, Rosaria Matarese SM, Conte ML, Miraglia del Giudice E. Evaluation of body iron status in Italian carriers of beta-thalassemia trait. Nutr Res 2001;21:55–6.CrossrefGoogle Scholar

  • 3.

    Bibi A, Benmoussa S, Torjman A, Taboubi N, Ouali F, Cherif H, et al. Intérêt de la dissociation albumine-transferrine (dat) dans le diagnostic de la carence martiale dans une cohorte de 1288 écoliers dans une région du grand Tunis. Ann Biol Clin 2006;64:1–9.Google Scholar

  • 4.

    Mentzer WC Jr. Differentiation of iron deficiency from thalassemia trait. Lancet 1973;1:882.CrossrefGoogle Scholar

  • 5.

    Green R, King R. A new red blood cell discriminant incorporating volume dispersion for differentiating iron deficiency anemia from thalassemia minor. Blood Cells 1989;15:481–95.PubMedGoogle Scholar

  • 6.

    Jayabose S, Giavanelli J, Levendoglu-Tugal O, Sandoval C, Ozkaynak F, Visintainer P. Differentiating iron deficiency anemia from thalassemia minor by using an RDW-based index. J Pediatr Hematol 1999;21:314.CrossrefGoogle Scholar

  • 7.

    England JM, Fraser PM. Differentiation of iron deficiency from thalassemia trait by routine blood count. Lancet 1973;1:449–52.PubMedCrossrefGoogle Scholar

  • 8.

    Shine L, Lal S. A strategy to detect beta-thalassemia minor. Lancet 1977;1:692–4.PubMedCrossrefGoogle Scholar

  • 9.

    Srivastava PC. Differentiation of thalassemia minor from iron deficiency. Lancet 1973;2:154–5.PubMedGoogle Scholar

  • 10.

    Ricerca BM, Stortis S, d’Onofrio G, Mancini S, Vittori M, Campisi S, et al. Differentiation of iron deficiency from thalassemia trait: a new approach. Haematologica 1987;72:409–13.PubMedGoogle Scholar

  • 11.

    Ehsani M, Darvish A, Aslani A, Seighali F. A new formula for differentiation if iron deficiency anemia (IDA) and thalassemia trait (TT). Turk J Hematol 2005;22:268.Google Scholar

  • 12.

    Sirdah MI, Tarazi E, Al Najjar E, Al Haddad R. Evaluation of the diagnostic reliability of different RBC indices and formulas in the differentiation of the β-thalassemia minor from iron deficiency in Palestinian population. Int J Lab Hematol 2008;30:324–30.CrossrefWeb of SciencePubMedGoogle Scholar

  • 13.

    Huber AR, Ottiger C, Risch L. Thalassemie-syndrome: klinik und diagnose. Schweiz Med Forum 2004;4:947–52.Google Scholar

  • 14.

    Klee GG, Fairbanks VF, Pierre RV, O’Sullivan MB. Routine erythrocyte measurements in diagnosis of iron deficiency anemia and thalassemia minor. Am J Clin Pathol 1976;66:870–7.PubMedWeb of ScienceGoogle Scholar

  • 15.

    Marti HR, Fisher S, Killer D, Bürgi W. Can automated haematology analysers discriminate thalassemia from iron deficiency? Acta Haematol 1987;78:180–3.PubMedCrossrefGoogle Scholar

  • 16.

    Poncz M, Solowiejczyk D, Harpel B, Mory Y, Schwartz E, Surrey S. Construction of human gene libraries from small amounts of peripheral blood: analysis of β-like globin genes. Hemoglobin 1982;6:27–33.PubMedCrossrefGoogle Scholar

  • 17.

    Maggio A, Giambona A, Cai SP, Wall J, Kan YW, Chehab FF. Rapid and simultaneous typing of hemoglobin S, hemoglobin C and seven Mediterranean β-thalassemia mutations by covalent reverse dot blot analysis: application to prenatal diagnosis in Sicily. Blood 1993;81:239–42.PubMedGoogle Scholar

  • 18.

    Old JM, Khan SN, Verma I, Fucharoen S, Kleanthous M, Loannou P, et al. A multi-center study in order to further define the molecular basis of β-thalassemia in Thailand, Pakistan, Sri Lanka, Mauritius, Syria, and India, and to develop a simple molecular diagnostic strategy by amplification refractory mutation system-polymerase chain reaction. Hemoglobin 2001;25:397–407.PubMedGoogle Scholar

  • 19.

    Fattoum S, Messaoud T, Bibi A. A molecular basis of beta-thalassemia in the population of Tunisia. Hemoglobin 2004;28:177–87.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 20.

    Bibi A, Messaoud T, Beldjord C, Fattoum S. Detection of two rare β-thalassemia alleles found in the Tunisian population: codon 47 (+A) and codons 106/107 (+G). Hemoglobin 2006;30:437–47.PubMedCrossrefGoogle Scholar

  • 21.

    Bessman JD, Feinstein DI. Quantitative anisocytosis as a discriminant between iron deficiency and thalassemia minor. Blood 1979;53:288–93.PubMedGoogle Scholar

  • 22.

    England JM, Fraser P. Discrimination between iron deficiency and heterozygous-thalassaemia syndromes in differential diagnosis of microcytosis. Lancet 1979;1:145–8.PubMedCrossrefGoogle Scholar

  • 23.

    Ntaios GA, Chatzinikolaou A, Saouli Z, Girtovitis F, Tsapanidou M, Kaiafa G, et al. Discrimination indices as screening tests for beta-thalassemia trait. Ann Hematol 2007;86:487–91.PubMedCrossrefGoogle Scholar

  • 24.

    Ehsani M, Shahgholi E, Rahiminejad M, Seighali F, Rashidi A. A new index for discrimination between iron deficiency anemia and beta-thalassemia trait minor: results in 284 patients. Pak J Biol Sci 2009;12:473–5.Google Scholar

  • 25.

    Urrechaga E, Borque L, Escanero JF. The role of automated measurement of RBC subpopulations in differential diagnosis of microcytic anemia and β-thalassemia screening. Am J Clin Pathol 2011;135:374–9.Web of ScienceCrossrefPubMedGoogle Scholar

  • 26.

    Alfadhli S, Alawadhi A, Alkhaldi D. Validity assessment of nine discriminant functions used for the differentiation between iron deficiency anemia and thalassemia minor. J Tropical Pediatr 2006;53:93–7.Web of ScienceCrossrefGoogle Scholar

  • 27.

    Janel A, Roszky L, Rapatel C, Mareynat G, Berger MG, Serre-Sapin AF. Proposal of a score combining red blood cell indices for early differentiation of beta-thalassemia minor from iron deficiency anemia. Hematology 2011;16:123–7.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 28.

    Okan V, Cigiloglu A, Cifci S. Red cell indices and functions differentiating patients with the β-thalassemia trait from those with iron deficiency anemia. J Int Med Res 2009;37:25–30.CrossrefWeb of SciencePubMedGoogle Scholar

  • 29.

    Shen C, Jianq YM, Shi H, Liu JH, Zhou WJ, Dai QK, et al. Evaluation of indices in differentiation between iron deficiency anemia and β-thalassemia trait for Chinese children. J Pediatr Hematol Oncol 2010;32:218–22.CrossrefWeb of ScienceGoogle Scholar

  • 30.

    Huisman TH, Carver MF. The β- and δ-thalassemia repository, 9th ed., part I. Hemoglobin 1998;22:169–95.CrossrefGoogle Scholar

  • 31.

    Sahli CA, Bibi A, Ouali F, Hajer S, Hadj Fredj S, Othmeni R, et al. δ0-thalassemia in cis of βKnossos globin gene: first homozygous description in Thalassemia Intermedia Libyans and first combination with Codon 39 in Thalassemia Intermedia Tunisian patient. Clin Chem Lab Med 2012;50:1743–8.PubMedWeb of ScienceGoogle Scholar

  • 32.

    Giambona A, Passarello C, Vinciguerra M, Li Muli R, Teresi P, Anzà M, et al. Significance of borderline hemoglobin A2 values in an Italian population with a high prevalence of β-thalassemia. Haematologica 2008;93:1380–4.Web of ScienceGoogle Scholar

  • 33.

    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.PubMedCrossrefGoogle Scholar

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.

Export Citation

©2013 by Walter de Gruyter Berlin Boston.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
Lieshu Tong, Josef Kauer, Sebastian Wachsmann-Hogiu, Kaiqin Chu, Hu Dou, and Zachary J. Smith
Scientific Reports, 2017, Volume 7, Number 1
[2]
F. Ouali, H. Siala, A. Bibi, S. Hadj Fredj, B. Dakhlaoui, R. Othmani, F. Ouenniche, F. Zouari, B. Bouguerra, H. Rezigua, S. Fattoum, and T. Messaoud
International Journal of Laboratory Hematology, 2016, Volume 38, Number 3, Page 223
[3]
Erdim Sertoglu, Huseyin Kayadibi, and Metin Uyanik
Rheumatology International, 2015, Volume 35, Number 4, Page 765
[4]
Sandra S. Lazarte, María E. Mónaco, Ana C. Haro, Cecilia L. Jiménez, Myriam E. Ledesma Achem, and Blanca A. Issé
Hemoglobin, 2014, Volume 38, Number 6, Page 394

Comments (0)

Please log in or register to comment.
Log in