Wonke B, Modell M, Marlow T, Khan M, Modell B
Haematology Department, Whittington Hospital, and Royal Free and University College Medical School Department of Primary Care and Population Sciences, Highgate Hill, London, UK.
Scand J Clin Lab Invest. 2007;67(1):87-95. doi: 10.1080/00365510601046474.
The high prevalence of microcytosis (defined here as mean cell haemoglobin<27 pg) with no other abnormality is a principal cause of confusion in screening for haemoglobin disorders. Here we report the results of a small pilot study aiming to resolve this confusion by routinely proceeding to plasma ferritin and HPLC assay, using the original sequestrene blood sample, when microcytosis is detected. Participants comprised a random sample of 1,302 people referred for a full blood count by their General Practitioner (GP) to the laboratory of a North London district general hospital serving a multi-ethnic inner-city population. Ethnicity was established by questionnaire. In North Europeans, microcytosis was present in 3% of males (half were iron-deficient) and 11% of females (most were iron-deficient). Among ethnic minorities, microcytosis was present in 35% of males (one tenth were iron-deficient), and 45% of females (less than half were iron-deficient): an exclusion diagnosis of "probable alpha thalassaemia" could be made in the remainder. We conclude that when microcytosis is present, routine further analysis of the original sequestrene sample by plasma ferritin assay and haemoglobinopathy screening could lead to a more efficient and cost-effective laboratory service for primary care and maternity services.
单纯小细胞性贫血（本文定义为平均红细胞血红蛋白<27 pg）的高发病率且无其他异常情况，是血红蛋白疾病筛查中造成混淆的主要原因。在此，我们报告一项小型试点研究的结果，该研究旨在通过在检测到小细胞性贫血时，使用原始的去铁胺血样常规进行血浆铁蛋白和高效液相色谱分析来解决这一混淆问题。参与者包括由全科医生（GP）转介到一家为多民族市中心人口服务的北伦敦地区综合医院实验室进行全血细胞计数的1302人的随机样本。通过问卷调查确定种族。在北欧人中，3%的男性存在小细胞性贫血（其中一半缺铁），11%的女性存在小细胞性贫血（大多数缺铁）。在少数民族中，35%的男性存在小细胞性贫血（十分之一缺铁），45%的女性存在小细胞性贫血（不到一半缺铁）：其余可排除诊断为“可能的α地中海贫血”。我们得出结论，当存在小细胞性贫血时，通过血浆铁蛋白测定和血红蛋白病筛查对原始去铁胺样本进行常规进一步分析，可为初级保健和产科服务带来更高效且具成本效益的实验室服务。
