Bentley S A, Ayscue L H, Watson J M, Ross D W
Department of Pathology, University of North Carolina School of Medicine, Chapel Hill 27514.
Blood Cells. 1989;15(3):575-82; discussion 583-4.
Several groups of authors have derived discriminant functions (DFs) based on red cell indices (primarily MCH, MCV, and RDW) that can be used to differentiate iron deficiency from thalassemia minor. The Technicon H*1 analyzer provides a direct MCHC measurement (termed the CHCM), in addition to the conventional computed value (Hgb/PCV). To evaluate the clinical utility of red cell discriminant analysis, chart review was performed in 176 cases for which hemoglobin characterization and quantitation studies had been requested. Six published discriminants were evaluated for cases of clearly defined iron deficiency anemia and thalassemia minor. Overall diagnostic efficiency ranged from 50%-82%, and the diagnostic performance of three of the discriminants failed to achieve statistical significance. Mean values for both MCHC and CHCM were significantly lower in patients with iron deficiency than in patients with other causes of microcytic anemia. It was also observed that MCHC was significantly greater than CHCM in patients with iron deficiency anemia, but not in patients with other causes of microcytic anemia. Both MCHC and the difference between MCHC and CHCM showed potential value as parameters for the differential diagnosis of iron deficiency from other causes of microcytic anemia. It was noted, however, that in 67% of the cases studied, the use of a DF could not have resolved the diagnosis to the extent that hemoglobin characterization and quantitation studies were no longer indicated.
几组作者基于红细胞指数（主要是平均红细胞血红蛋白含量、平均红细胞体积和红细胞分布宽度）推导出了判别函数（DFs），这些函数可用于区分缺铁性贫血和轻型地中海贫血。Technicon H*1分析仪除了提供传统计算值（血红蛋白/红细胞压积）外，还能直接测量平均红细胞血红蛋白浓度（称为CHCM）。为了评估红细胞判别分析的临床实用性，对176例要求进行血红蛋白特征和定量研究的病例进行了病历回顾。对已发表的六种判别方法在明确诊断的缺铁性贫血和轻型地中海贫血病例中进行了评估。总体诊断效率在50%-82%之间，其中三种判别方法的诊断性能未达到统计学意义。缺铁患者的平均红细胞血红蛋白浓度和直接测量的平均红细胞血红蛋白浓度均值均显著低于其他小细胞性贫血病因的患者。还观察到，缺铁性贫血患者的平均红细胞血红蛋白浓度显著高于直接测量的平均红细胞血红蛋白浓度，而其他小细胞性贫血病因的患者则不然。平均红细胞血红蛋白浓度以及平均红细胞血红蛋白浓度与直接测量的平均红细胞血红蛋白浓度之间的差值，作为区分缺铁性贫血与其他小细胞性贫血病因的参数均显示出潜在价值。然而，需要注意的是，在所研究的病例中，有67%的病例使用判别函数并不能解决诊断问题，以至于不再需要进行血红蛋白特征和定量研究。
