BACKGROUND Iron deficiency anemia(IDA)and thalassemia trait(TT)are the most common microcytic and hypochromic anemias.Differentiation between mild TT and early IDA is still a clinical challenge.AIM To develop and vali...BACKGROUND Iron deficiency anemia(IDA)and thalassemia trait(TT)are the most common microcytic and hypochromic anemias.Differentiation between mild TT and early IDA is still a clinical challenge.AIM To develop and validate a new index for discriminating between IDA and TT.METHODS Blood count data from 126 patients,consisting of 43 TT patients and 83 IDA pa-tients,was retrospectively analyzed to develop a new index formula.This formula was further validated in another 61 patients,consisting of 48 TT patients and 13 IDA patients.RESULTS The new index is the ratio of hemoglobin to mean corpuscular volume.Its sen-sitivity,specificity,accuracy,Youden’s Index,area under the receiver operating characteristic curve,and Kappa coefficient in discriminating between IDA and TT were 93.5%,78.4%,83.3%,0.72,0.97,and 0.65,respectively.CONCLUSION This new index has good diagnostic performance in discriminating between mild TT and early IDA.It requires only two results of complete blood count,which can be a very desirable feature in under-resourced scenarios.展开更多
Alpha-thalassemia trait and sickle trait are not commonly considered risk factors of ischemic heart disease.We report the case of a non-atherosclerotic silent myocardial infarction in a 46-year-old woman,carrier of th...Alpha-thalassemia trait and sickle trait are not commonly considered risk factors of ischemic heart disease.We report the case of a non-atherosclerotic silent myocardial infarction in a 46-year-old woman,carrier of the alphathalassemia trait(homozygous deletion of locus-3.7) combined with sickle cell trait.While the patient was included as healthy volunteer for a metabolic study,we performed cardiac magnetic resonance imagery showing a left ventricle apicolateral myocardial infarction.Coronary computed tomography angiography showed normal coronary arteries with a coronary calcium score of 0.The patient was treated with low-dose aspirin in secondary prevention afterwards.This case allows us to discuss cardiovascular risk among patients presenting with both alpha-thalassemia trait and sickle cell trait and the indication of cardiac imagery in such patients even when considered as low-cardiovascular risk.展开更多
Background: The most common causes of microcytic hypochromic anemia are iron deficiency anemia (IDA) and the beta-thalassemia trait (β-TT). The aim of the work is to compare the validity of the various simple indices...Background: The most common causes of microcytic hypochromic anemia are iron deficiency anemia (IDA) and the beta-thalassemia trait (β-TT). The aim of the work is to compare the validity of the various simple indices to differentiate between iron deficiency anemia and β-thalassemia trait. Subjects and methods: A total of 2000 individuals were screened, by complete blood picture, measurement of serum iron, serum ferritin and hemoglobin separation;224 patients were detected as having hypochromia and microcytosis. Among them 166 cases were IDA and 58 cases were β-TT. We calculated 11 discrimination indices. The number of correctly identified cases were determined, sensitivity, specificity, positive and negative predictive value and Youden’s index (YI) of each discrimination index was calculated. Results: The percentage of correctly diagnosed patients is highest for Matos and Carvalho index (MCI) (95.5%) which is closely followed by Red cell distribution width index (RDWI) (93.7%). The third high index was Green and King (GKI) (91.9%). Sensitivity, specificity of MCI for detection of IDA was found 98.8%, 87.9% respectively. For β-TT, sensitivity and specificity was found 86.2% and 98.8% respectively. The YI of MCI was found 85.9%. It is followed by RDWI;its sensitivity and specificity for detection of IDA was found 97.6%, 85.3%. For β-TT, sensitivity and specificity was found 82.7% and 97.6% respectively. The YI of RDWI was 81.6%. Conclusion: Matos and Carvalho index and RDWI are easily available automated cell-count-based indices coming out as good discriminator between IDA and β-TT in our study.展开更多
目的探讨红细胞参数计算公式对儿童β-地中海贫血(β-TT)诊断的意义及其影响因素分析。方法选择200例小细胞低色素性贫血的临床资料进行回顾性分析。其中β-TT 104例,缺铁性贫血(IDA)96例。将相关的红细胞参数分别代入Green and King指...目的探讨红细胞参数计算公式对儿童β-地中海贫血(β-TT)诊断的意义及其影响因素分析。方法选择200例小细胞低色素性贫血的临床资料进行回顾性分析。其中β-TT 104例,缺铁性贫血(IDA)96例。将相关的红细胞参数分别代入Green and King指数(GKI)及Mentzer指数(MI)计算得出相应的结果。分别以GKI=65(β-TT≤65,IDA>65)、GKI=73(β-TT≤73,IDA>73)、MI=13(β-TT≤13,IDA>13)为诊断界值,比较这3种方法对于鉴别β-TT和IDA的敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)及约登指数(YI),绘制受试者工作特征(ROC)曲线及计算曲线下面积(AUC),并分析影响鉴别效能较好的计算公式的准确性的可能因素。结果本地区儿童β-TT基因缺陷类型以CD41-42(-TTCT)杂合突变、IVS-Ⅱ-654(C→T)杂合突变和CD17(A→T)杂合突变为主。MI(β-TT≤13,IDA>13)的诊断效能明显高于GKI(β-TT≤65,IDA>65或β-TT≤73,IDA>73),差异均有统计学意义(P<0.05),MI的AUC为0.840;以MI=13为最佳界值,YI=63.06%。年龄≤4个月的患儿使用MI的准确性偏低(P<0.05),性别和检测前是否使用铁剂治疗对MI的准确性无影响(P>0.05)。结论MI(β-TT≤13,IDA>13)对于鉴别β-TT和IDA具有较高的临床价值,为保障MI的准确性,建议适用年龄>4个月,对于年龄≤4个月的患儿建议联合血红蛋白电泳和地中海贫血基因检测以提高检查的准确性。展开更多
目的:评价红细胞参数及运算公式在广东深圳地区儿童地中海贫血(thalassemia trait,TT)和缺铁性贫血(iron deficiency anemia,IDA)鉴别诊断中的效能。方法:选取849例来自广东深圳地区的儿童患者,其中TT 536例,IDA 313例。应用5个红细胞参...目的:评价红细胞参数及运算公式在广东深圳地区儿童地中海贫血(thalassemia trait,TT)和缺铁性贫血(iron deficiency anemia,IDA)鉴别诊断中的效能。方法:选取849例来自广东深圳地区的儿童患者,其中TT 536例,IDA 313例。应用5个红细胞参数[分别为红细胞计数(RBC)、红细胞平均体积(MCV)、平均红细胞血红蛋白量(MCH)、红细胞平均血红蛋白浓度(MCHC)和红细胞分布宽度(RDW)]及10个红细胞参数运算公式(分别为Mentzer公式、Green and King公式、Srivastava公式、Ricerca公式、RDWI公式、Sirdah公式、Huber-Herklotz公式、Ehsani公式、Shine and Lal公式和England and Fraser公式),对其敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)以及约登指数(YI)进行分析,绘制受试者工作特征(ROC)曲线。结果:Green and King公式的鉴别诊断价值最高,其YI最高(63.7%),诊断TT的SEN为82.5%,SPE为81.2%,ROC曲线下面积(AUC)最高,为0.875;其次是RDWI公式,其YI、SEN、SPE以及AUC分别为62.8%、79.1%、83.7%及0.870。结论:在广东深圳地区儿童群体中,Green and King公式和RDWI公式具有较好地鉴别诊断TT和IDA的能力。展开更多
目的评价缺铁性贫血(IDA)和β地中海贫血(β-TT)的鉴别诊断公式在四川自贡地区人群中的应用价值。方法选取760例来自四川自贡地区患者,其中β-TT 255例、IDA505例,应用红细胞(RBC)参数计算出10个鉴别公式(分别为Shine and Lal公式、Gree...目的评价缺铁性贫血(IDA)和β地中海贫血(β-TT)的鉴别诊断公式在四川自贡地区人群中的应用价值。方法选取760例来自四川自贡地区患者,其中β-TT 255例、IDA505例,应用红细胞(RBC)参数计算出10个鉴别公式(分别为Shine and Lal公式、Green and King公式、Mentzer公式、RDWI公式、Srivastava公式、Ricerca公式、England and Fraser公式、Ehsani公式、Sirdah公式和Huber-Herklotz公式)的敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)、约登指数(YI),并绘制受试者工作特征(ROC)曲线。结果 Mentzer公式的诊断价值最高,其YI最高(80.1%),诊断IDA的SEN为97.0%,SPE为83.1%,曲线下面积(AUC)最高(0.971);其次为RDWI公式,YI、SEN、SPE、AUC分别为72.8%、95.2%、77.6%、0.961。结论在四川自贡地区人群中Mentzer公式和RDWI公式具有较好的鉴别诊断IDA和β-TT的能力。展开更多
基金The study was reviewed and approved by the Shanghai Tenth People’s Hospital Institutional Review Board(Approval No.23K190).
文摘BACKGROUND Iron deficiency anemia(IDA)and thalassemia trait(TT)are the most common microcytic and hypochromic anemias.Differentiation between mild TT and early IDA is still a clinical challenge.AIM To develop and validate a new index for discriminating between IDA and TT.METHODS Blood count data from 126 patients,consisting of 43 TT patients and 83 IDA pa-tients,was retrospectively analyzed to develop a new index formula.This formula was further validated in another 61 patients,consisting of 48 TT patients and 13 IDA patients.RESULTS The new index is the ratio of hemoglobin to mean corpuscular volume.Its sen-sitivity,specificity,accuracy,Youden’s Index,area under the receiver operating characteristic curve,and Kappa coefficient in discriminating between IDA and TT were 93.5%,78.4%,83.3%,0.72,0.97,and 0.65,respectively.CONCLUSION This new index has good diagnostic performance in discriminating between mild TT and early IDA.It requires only two results of complete blood count,which can be a very desirable feature in under-resourced scenarios.
文摘Alpha-thalassemia trait and sickle trait are not commonly considered risk factors of ischemic heart disease.We report the case of a non-atherosclerotic silent myocardial infarction in a 46-year-old woman,carrier of the alphathalassemia trait(homozygous deletion of locus-3.7) combined with sickle cell trait.While the patient was included as healthy volunteer for a metabolic study,we performed cardiac magnetic resonance imagery showing a left ventricle apicolateral myocardial infarction.Coronary computed tomography angiography showed normal coronary arteries with a coronary calcium score of 0.The patient was treated with low-dose aspirin in secondary prevention afterwards.This case allows us to discuss cardiovascular risk among patients presenting with both alpha-thalassemia trait and sickle cell trait and the indication of cardiac imagery in such patients even when considered as low-cardiovascular risk.
文摘Background: The most common causes of microcytic hypochromic anemia are iron deficiency anemia (IDA) and the beta-thalassemia trait (β-TT). The aim of the work is to compare the validity of the various simple indices to differentiate between iron deficiency anemia and β-thalassemia trait. Subjects and methods: A total of 2000 individuals were screened, by complete blood picture, measurement of serum iron, serum ferritin and hemoglobin separation;224 patients were detected as having hypochromia and microcytosis. Among them 166 cases were IDA and 58 cases were β-TT. We calculated 11 discrimination indices. The number of correctly identified cases were determined, sensitivity, specificity, positive and negative predictive value and Youden’s index (YI) of each discrimination index was calculated. Results: The percentage of correctly diagnosed patients is highest for Matos and Carvalho index (MCI) (95.5%) which is closely followed by Red cell distribution width index (RDWI) (93.7%). The third high index was Green and King (GKI) (91.9%). Sensitivity, specificity of MCI for detection of IDA was found 98.8%, 87.9% respectively. For β-TT, sensitivity and specificity was found 86.2% and 98.8% respectively. The YI of MCI was found 85.9%. It is followed by RDWI;its sensitivity and specificity for detection of IDA was found 97.6%, 85.3%. For β-TT, sensitivity and specificity was found 82.7% and 97.6% respectively. The YI of RDWI was 81.6%. Conclusion: Matos and Carvalho index and RDWI are easily available automated cell-count-based indices coming out as good discriminator between IDA and β-TT in our study.
文摘目的探讨红细胞参数计算公式对儿童β-地中海贫血(β-TT)诊断的意义及其影响因素分析。方法选择200例小细胞低色素性贫血的临床资料进行回顾性分析。其中β-TT 104例,缺铁性贫血(IDA)96例。将相关的红细胞参数分别代入Green and King指数(GKI)及Mentzer指数(MI)计算得出相应的结果。分别以GKI=65(β-TT≤65,IDA>65)、GKI=73(β-TT≤73,IDA>73)、MI=13(β-TT≤13,IDA>13)为诊断界值,比较这3种方法对于鉴别β-TT和IDA的敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)及约登指数(YI),绘制受试者工作特征(ROC)曲线及计算曲线下面积(AUC),并分析影响鉴别效能较好的计算公式的准确性的可能因素。结果本地区儿童β-TT基因缺陷类型以CD41-42(-TTCT)杂合突变、IVS-Ⅱ-654(C→T)杂合突变和CD17(A→T)杂合突变为主。MI(β-TT≤13,IDA>13)的诊断效能明显高于GKI(β-TT≤65,IDA>65或β-TT≤73,IDA>73),差异均有统计学意义(P<0.05),MI的AUC为0.840;以MI=13为最佳界值,YI=63.06%。年龄≤4个月的患儿使用MI的准确性偏低(P<0.05),性别和检测前是否使用铁剂治疗对MI的准确性无影响(P>0.05)。结论MI(β-TT≤13,IDA>13)对于鉴别β-TT和IDA具有较高的临床价值,为保障MI的准确性,建议适用年龄>4个月,对于年龄≤4个月的患儿建议联合血红蛋白电泳和地中海贫血基因检测以提高检查的准确性。
文摘目的:评价红细胞参数及运算公式在广东深圳地区儿童地中海贫血(thalassemia trait,TT)和缺铁性贫血(iron deficiency anemia,IDA)鉴别诊断中的效能。方法:选取849例来自广东深圳地区的儿童患者,其中TT 536例,IDA 313例。应用5个红细胞参数[分别为红细胞计数(RBC)、红细胞平均体积(MCV)、平均红细胞血红蛋白量(MCH)、红细胞平均血红蛋白浓度(MCHC)和红细胞分布宽度(RDW)]及10个红细胞参数运算公式(分别为Mentzer公式、Green and King公式、Srivastava公式、Ricerca公式、RDWI公式、Sirdah公式、Huber-Herklotz公式、Ehsani公式、Shine and Lal公式和England and Fraser公式),对其敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)以及约登指数(YI)进行分析,绘制受试者工作特征(ROC)曲线。结果:Green and King公式的鉴别诊断价值最高,其YI最高(63.7%),诊断TT的SEN为82.5%,SPE为81.2%,ROC曲线下面积(AUC)最高,为0.875;其次是RDWI公式,其YI、SEN、SPE以及AUC分别为62.8%、79.1%、83.7%及0.870。结论:在广东深圳地区儿童群体中,Green and King公式和RDWI公式具有较好地鉴别诊断TT和IDA的能力。
文摘目的探讨红细胞指数用于鉴别缺铁性贫血(iron deficiency anemia,IDA)与地中海贫血特质(thalassemia trait,TT)患者的应用价值和最佳界值。方法选取2017年10月1日至2021年3月31日北京和睦家医院确诊为IDA或TT的中国患者40例。根据血常规结果,计算8种红细胞指数,分析其对于鉴别IDA或TT的灵敏度与特异度、约登指数,根据ROC探讨其在我国患者中的适合界值。结果40例患者中有22例IDA和18例TT。Jayabose、Green and King和Ricerca 3种红细胞指数用于鉴别IDA和TT的约登指数分别为0.667、0.667和0.682,ROC的AUC分别为0.990、0.995和0.992,均为十分可靠的指标。同时,Jayabose、Green and King和Ricerca 3种红细胞指数的最适合界值分别为251.69、79.56和3.91。调整界值后,Jayabose、Green and King和Ricerca 3种红细胞指数鉴别IDA和TT的准确率均提高至97.5%。结论含有红细胞分布宽度指标的红细胞指数对于鉴别我国小细胞低色素性贫血患者的病因具有很高的应用价值,值得临床推广。
文摘目的评价缺铁性贫血(IDA)和β地中海贫血(β-TT)的鉴别诊断公式在四川自贡地区人群中的应用价值。方法选取760例来自四川自贡地区患者,其中β-TT 255例、IDA505例,应用红细胞(RBC)参数计算出10个鉴别公式(分别为Shine and Lal公式、Green and King公式、Mentzer公式、RDWI公式、Srivastava公式、Ricerca公式、England and Fraser公式、Ehsani公式、Sirdah公式和Huber-Herklotz公式)的敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)、约登指数(YI),并绘制受试者工作特征(ROC)曲线。结果 Mentzer公式的诊断价值最高,其YI最高(80.1%),诊断IDA的SEN为97.0%,SPE为83.1%,曲线下面积(AUC)最高(0.971);其次为RDWI公式,YI、SEN、SPE、AUC分别为72.8%、95.2%、77.6%、0.961。结论在四川自贡地区人群中Mentzer公式和RDWI公式具有较好的鉴别诊断IDA和β-TT的能力。
