Saboor Muhammad
Clin Lab. 2021 Apr 1;67(4). doi: 10.7754/Clin.Lab.2020.200644.
Iron deficiency and thalassemia are two commonly encountered microcytic and hypochromic anemias. The primary objective was to find the best discriminant formula between alpha thalassemia and iron deficiency to be used in premarital screening centers. The secondary objective, was to find cutoff values that might differentiate alpha thalassemia, beta thalassemia, and iron deficiency collectively.
A total of 224 females divided into four groups (normal, alpha thalassemia, beta thalassemia, and iron deficiency) were recruited in this study after carrying out complete blood count, hemoglobin electrophoresis, serum ferritin, and molecular analysis. Based upon the laboratory data, 26 discriminant formulas (DF) were applied to differentiate alpha thalassemia, beta thalassemia, and iron deficiency anemia. Receiver Operating Characteristic (ROC) curve was constructed and sensitivity, specificity, and Youden's index were determined.
In this study, Shine and Lal, Ehsani, Telissani, Sirachainan, Hisham, Kandhro 2, and Mantos indexes showed 100% sensitivity, specificity, Youden's index, and 1.00 AUC for differentiating alpha thalassemia from iron deficient group. Formulas that showed best sensitivity and specificity (100%) in the discrimination of beta thalassemia and iron deficiency were Mentzer, Shine & Lal, Sarivastava & Bevington, and Sirachainan index (AUC 1.00). AUC of Mentzer index was lower (0.988 vs. 1.00) in differentiating alpha thalassemia and iron deficiency than beta thalassemia and iron deficiency.
Almost all discriminant formulas can be utilized for the prediction of microcytic anemia in a premarital setup after excluding beta thalassemia; however, further confirmation is mandatory for genetic counselling and iron supplementation. Furthermore, Bordbar, Kerman index I, and Huber-Herklotz index showed the lowest performance in the discrimination of alpha thalassemia and iron deficiency.
缺铁性贫血和地中海贫血是两种常见的小细胞低色素性贫血。主要目的是找到用于婚前筛查中心的区分α地中海贫血和缺铁性贫血的最佳判别公式。次要目的是找到能够共同区分α地中海贫血、β地中海贫血和缺铁性贫血的临界值。
本研究招募了224名女性，她们被分为四组（正常、α地中海贫血、β地中海贫血和缺铁性贫血），并进行了全血细胞计数、血红蛋白电泳、血清铁蛋白和分子分析。基于实验室数据，应用26种判别公式（DF）来区分α地中海贫血、β地中海贫血和缺铁性贫血。构建了受试者工作特征（ROC）曲线，并确定了敏感性、特异性和尤登指数。
在本研究中，Shine和Lal、Ehsani、Telissani、Sirachainan、Hisham、Kandhro 2和Mantos指数在区分α地中海贫血和缺铁组时显示出100%的敏感性、特异性、尤登指数和1.00的曲线下面积（AUC）。在区分β地中海贫血和缺铁性贫血时显示出最佳敏感性和特异性（100%）的公式是Mentzer、Shine & Lal、Sarivastava & Bevington和Sirachainan指数（AUC为1.00）。在区分α地中海贫血和缺铁性贫血时，Mentzer指数的AUC（0.988对1.00）低于区分β地中海贫血和缺铁性贫血时的AUC。
几乎所有判别公式都可用于在排除β地中海贫血后对婚前小细胞贫血进行预测；然而，对于遗传咨询和铁补充，还需要进一步确认。此外，Bordbar、克尔曼指数I和Huber-Herklotz指数在区分α地中海贫血和缺铁性贫血方面表现最差。
