Skip to main content
SpringerLink
Log in

Role of Hematological Indices as a Screening Tool of Beta Thalassemia Trait in Eastern Uttar Pradesh: An Institutional Study

  • Original Article
  • Published:
Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

A large majority of microcytic hypochromic anemia have defects in cellular hemoglobin synthesis due to either iron deficiency or thalassemia trait; both differing in management and prognosis. HPLC and serum iron profile as confirmatory tests are unavailable at health care centers. Blanket therapy of iron supplements is therefore given in all such cases which may cause iron overload in thalassemia cases. Easy to use and cost effective screening methods are desirable. The present study was undertaken to evaluate the diagnostic accuracy of twelve indices to effectively screen cases of thalassemia trait and differentiate them from iron deficiency anemia. Routine samples from the hematology lab with Hb < 13 gm/dl, MCV < 80 fl and MCH < 27 pg were screened. Taking HPLC and serum ferritin as gold standard, out of total 1353 cases, 98 cases of thalassemia trait (HbA2 > 3.5 on HPLC) and 1102 cases of iron deficiency anemia (serum ferritin < 12 g/ml) were evaluated using discrimination indices. Diagnostic accuracy for each index was calculated. While few indices showed a sensitivity of 100%, their specificity was low which meant more number of false positive cases. Based on Youden’s Index, which measures the diagnostic tests ability to balance sensitivity and specificity, the best three indices in the decreasing order of their efficacy in our study were Ricerca Index (RI), Green and King Index (GKI) and Mentzer Index (MI). MI is considered a reliable index by many clinicians since a long time, however RI and GKI were found to have a better diagnostic accuracy based on our study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Madan N, Sharma S, Sood SK, Colah R, Bhatia LH (2010) Frequency of β-thalassemia trait and other hemoglobinopathies in northern and western India. Indian J Hum Genet 16(1):16–25

    Article  CAS  Google Scholar 

  2. Sirdah M, Tarazi I, Al Najjar E, Al Haddad R (2008) Evaluation of the diagnostic reliability of different RBC indices and formulas in the differentiation of the beta-thalassaemia minor from iron deficiency in Palestinian population. Int J Lab Hematol 30(4):324–330

    Article  CAS  Google Scholar 

  3. Bhushan R, Shukla S, Singh D, Trivedi SS, Sharma S (2018) Reliability of different RBC indices to differentiate between beta thalassemia trait and iron deficiency anemia during antenatal screening. World J Pathol 7:14–20

    Google Scholar 

  4. Kumar A, Saha D, Kini J, Murali N, Chakraborti S, Adiga D (2017) The role of discriminant functions in screening beta thalassemia trait and iron deficiency anemia among laboratory samples. J Lab Physicians 9(3):195–201

    Article  CAS  Google Scholar 

  5. Meshram P, Kokandakar HR, Bindu RS (2017) Study of blood indices and high performance liquid chromatography (HPLC) in differentiation of β-thalassemia trait and iron deficiency anemia. Int J Res Med Sci 5(11):4728–4736

    Article  Google Scholar 

  6. Vehapoglu A, Ozgurhan G, Demir AD, Uzuner S, Nursoy MA et al (2014) Hematological indices for differential diagnosis of beta thalassemia trait and iron deficiency anemia. Anemia. https://doi.org/10.1155/2014/576738

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chuan S, Yong-mei J, Hua S, Jin-hao L, Wen-jie Z, Qing-kai D et al (2010) Evaluation of indices in differentiation between iron deficiency anemia and β-thalassemia trait for Chinese Children. J Pediatr Hematol Oncol 32(6):e218–e222

    Article  Google Scholar 

  8. Niazi M, Mohammad T, Raziq F, Hameed A (2010) Usefulness of red cell indices in differentiating microcytic hypochromic anemias. Gomal J Med Sci 8(2):125–129

    Google Scholar 

  9. Singh YK, Garg S, Srivastava A, Singh S, Jaiswal R (2016) Role of hematological indices in the screening of β-thalassemia minor (trait) and iron deficiency anemia. Am Res J Hematol 1(1):1–5

    Google Scholar 

  10. Rathod DA, Kaur A, Patel V, Patel K, Kabrawala R, Patel V, Patel M, Shah P (2007) Usefulness of cell counter-based parameters and formulas in detection of beta-thalassemia trait in areas of high prevalence. Am J Clin Pathol 128(4):585–589

    Article  Google Scholar 

  11. Mukhopadhyay D, Saha K, Sengupta M, Mitra S, Datta C, Mitra PK (2015) Role of discrimination indices in screening of beta-thalassemia trait in West Bengal, India: an institutional experience on 10,407 subjects. Saudi J Health Sci 4:151–155

    Article  CAS  Google Scholar 

  12. Demir A, Yarali N, Fisgin T, Duru F, Kara A (2002) Most reliable indices in differentiation between thalassemia trait and iron deficiency anemia. Pediatr Int 44(6):612–616

    Article  Google Scholar 

  13. Okan V, Cigiloglu A, Cifci S, Yilmaz M, Pehlivan M (2009) Red cell indices and functions differentiating patients with the β-thalassaemia trait from those with iron deficiency anemia. J Int Med Res 37:25–30

    Article  CAS  Google Scholar 

  14. AlFadhli SM, Al-Awadhi AM, AlKhaldi D (2007) Validity assessment of nine discriminant functions used for the differentiation between iron deficiency anemia and thalassemia minor. J Trop Pediatr 53(2):93–97

    Article  Google Scholar 

  15. Ntaios G, Chatzinikolaou A, Saouli Z, Girtovitis F, Tsapanidou M, Kaiafa G et al (2007) Discrimination indices as screening tests for beta-thalassemic trait. Ann Hematol 86(7):487–491

    Article  Google Scholar 

  16. Ehsani MA, Shahgholi E, Rahiminejad MS, Seighali F, Rashidi A (2009) A new index for discrimination between iron deficiency anemia and beta-thalassemia minor: results in 284 patients. Pak J Biol Sci 12:473–475

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, M.L.N. Medical College, George Town, Prayagraj, 211002, India

    Mudita Bhargava, Varsha Kumar, Vasudha Singh & Vatsala Misra

  2. Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India

    Himansha Pandey

  3. Department of Medicine, M.L.N. Medical College, George Town, Prayagraj, India

    Poonam Gupta

Authors
  1. Mudita Bhargava
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Varsha Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Himansha Pandey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vasudha Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vatsala Misra
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Poonam Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Varsha Kumar.

Ethics declarations

Conflict of interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhargava, M., Kumar, V., Pandey, H. et al. Role of Hematological Indices as a Screening Tool of Beta Thalassemia Trait in Eastern Uttar Pradesh: An Institutional Study. Indian J Hematol Blood Transfus 36, 719–724 (2020). https://doi.org/10.1007/s12288-020-01282-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12288-020-01282-z

Keywords

Search

Navigation