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Anemia. 2014;2014:576738. doi: 10.1155/2014/576738. Epub 2014 Apr 10.

Hematological indices for differential diagnosis of Beta thalassemia trait and iron deficiency anemia.

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Department of Pediatrics, School of Medicine, Bezmialem Vakif University, 34093 Istanbul, Turkey.
Department of Pediatrics, Suleymaniye Obstetrics and Gynecology Hospital, 34010 Istanbul, Turkey.
Department of Biochemistry, Istanbul Training and Research Hospital, 34098 Istanbul, Turkey.
Department of Pediatrics, Istanbul Training and Research Hospital, Istanbul, Turkey.



The two most frequent types of microcytic anemia are beta thalassemia trait ( β -TT) and iron deficiency anemia (IDA). We retrospectively evaluated the reliability of various indices for differential diagnosis of microcytosis and β -TT in the same patient groups.


A total of 290 carefully selected children aged 1.1-16 years were evaluated. We calculated 12 discrimination indices in all patients with hemoglobin (Hb) values of 8.7-11.4 g/dL. None of the subjects had a combined case of IDA and β -TT. All children with IDA received oral iron for 16 weeks, and HbA2 screening was performed after iron therapy. The patient groups were evaluated according to red blood cell (RBC) count; red blood distribution width index; the Mentzer, Shine and Lal, England and Fraser, Srivastava and Bevington, Green and King, Ricerca, Sirdah, and Ehsani indices; mean density of hemoglobin/liter of blood; and mean cell density of hemoglobin.


The Mentzer index was the most reliable index, as it had the highest sensitivity (98.7%), specificity (82.3%), and Youden's index (81%) for detecting β -TT; this was followed by the Ehsani index (94.8%, 73.5%, and 68.3%, resp.) and RBC count (94.8%, 70.5%, and 65.3%).


The Mentzer index provided the highest reliabilities for differentiating β -TT from IDA.

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