EVALUATION OF INDICES IN DIFFERENTIATION BETWEEN IRON DEFICIENCY ANEMIA AND THALASSEMIA TRAITS IN CHINESE POPULATION

Dan Ou¹, Yuan Zhou², Jibo Zhang², Chao Wang², Lihua Zhou², Bo Wen², Dan Peng^{1, 2, *}

¹Changde Hospital of University of South China, Changde Hunan 415000, China - ²The First People’s Hospital of Changde, Changde Hunan 415000, China

Introduction: Thalassemia trait (TT) and iron deficiency anemia (IDA) are the most common disorders of hypochromic microcytic anemia (HMA). And there are many red cell indexes and formulas have been established as simple, fast, and inexpensive tools to differentiate TT from IDA, even though one index may show greater sensitivity and specificity in one population while ineffective in another. 

Methods: In this study we evaluated the validity of 5 red cell indices and 21 formulas in differential diagnosis of TT and IDA in Changde City population. In this study, 642 cases of small cell hypochromic anemia, including 466 TT and 176 IDA were included. We calculated the sensitivity, specificity, Positive predictive value, negative predictive value, Youden’s Index and the area under receiver operative curve, and Gini Index were calculated by using decision trees and ROC curve analyses to evaluated the discriminating formula performance among TT and IDA group. 

Results: Our results showed that the Green and King Index was the most reliable index as they had the highest Sensitivty (82%) and Area Under Curve 0.86, as well as highest Youden’s (63%). The Green and King Index's Gini Index was 0.26, which is lower than the other formulas' Gini Index. 

Conclusions: The Green and King Index could is suitable for the screening of thalassemia patients in the hypochromic microcytic anemia group and has the best efficiency in distinguishing TT and IDA.