Differential Diagnosis Of Iron Deficiency Anemia And Beta Thalassemia Minor Via Different Discrimination Indexes In Patients Visiting Tertiary Care Hospitals Of Peshawar, Pakistan

Abstract

Background:

Beta thalassemia minor and iron deficiency anemia both exhibit microcytic hypochromic anemia commonly. Different screening indexes have been introduced in order to differentiate between BTT and iron deficiency anemia which are easy to approach and convenient.

Objective:

Our study aimed to differentiate and screen the BTT and iron deficiency anemia on the basis of different discrimination indexes in order to evaluate the accuracy, sensitivity, and specificity of those indexes.

Results:

In this study, data from 201 people were collected, in which 175 cases were confirmed diagnosed with heterozygous beta thalassemia having HbA2 equal to or greater than 3.5%. 26 out of 201 were presenting iron deficiency anemia confirmed via serum ferritin. Both genders were included in this study. Upon applying eight different discrimination indexes, none of them showed 100% specificity and sensitivity. However, Shine & Lal index was more sensitive (93%) in diagnosing BTT as compared to others. 166(94%) out of 175 confirmed cases were diagnosed to have beta thalassemia trait via the S&L index followed by the Ricerca index that screened about 74% of total diagnosed cases of beta thalassemia trait. RDWI was also helpful in screening beta thalassemia traits and diagnosed about 73% of confirmed cases of BTT. The order of sensitivity of indexes in detecting BTT is S&L > RICERCA > RDWI > MCHD > MI > E&F > SRIVASTAV > MDHL. E&F index and MDHL screened 92% of confirmed IDA cases showing 88% of sensitivity and were helpful in diagnosing iron deficiency anemia. The order of accuracy of indexes in diagnosing IDA is E&F = MDHL > SRIVASTAV > MI > RDWI= RICERCA > S&L > MCHD

Conclusion:

Upon studying the sensitivity and specificity of different discrimination indexes regarding BTT and IDA, none of them seemed 100% authentic and accurate to be relied upon. Only RICERCA appears to be the most reliable index to discriminate between BTT and IDA One should go for diagnostic lab tests after being screened with the discrimination index for getting correct and specific treatment and prevent any unpleasant condition upon relying and diagnosis on the basis of discrimination index. The discrimination index is helpful in screening some cases of BTT and IDA but it doesn’t perfectly screen all cases.