Causes of microcytic anaemia and evaluation of conventional laboratory parameters in the differentiation of erythrocytic microcytosis in blood donors candidates

Diagnostic Performance of 10 Mathematical Formulae for Identifying Blood Donors with Thalassemia Trait

OBJECTIVE

To compare the diagnostic performance of 10 mathematical formulae for identifying thalassemia trait in blood donors.

METHODS

Compete blood counts were conducted on peripheral blood specimens using the UniCel DxH 800 hematology analyzer. Receiver operating characteristic curves were used to evaluate the diagnostic performance of each mathematical formula.

RESULTS

In the 66 donors with thalassemia and 288 subjects with no thalassemia analyzed, donors with thalassemia trait had lower values for mean corpuscular volume and mean corpuscular hemoglobin than subjects without thalassemia donors (77 fL vs 86 fL [P < .001]; 25 pg vs 28 pg [P < .001]). The formula developed by Shine and Lal in 1977 showed the highest area under the curve value, namely, 0.9. At the cutoff value of <1812, this formula had maximum specificity of 82.35% and sensitivity of 89.58%.

CONCLUSIONS

Our data indicate that the Shine and Lal formula has remarkable diagnostic performance in identifying donors with underlying thalassemia trait.

Discriminant indexes to simplify the differential diagnosis between iron deficiency anemia and thalassemia minor in individuals with microcytic anemia

INTRODUCTION

Microcytic anemias are very common in clinical practice, with iron deficiency anemia (IDA) and thalassemia minor (TT) being the most prevalent. Diagnostic confirmation of these clinical entities requires tests involving iron metabolism profile, hemoglobin electrophoresis, and molecular analysis. In this context, several discriminant indices have been proposed to simplify the differential diagnosis between IDA and TM.

OBJECTIVE

The aim of this paper was to demonstrate the clinical relevance of the use of discriminant indices in individuals with microcytic anemia to simplify the differential diagnosis between iron deficiency anemia and minor thalassemia.

METHODS

A bibliographic and cross-sectional search was performed in the PubMed, SciELO and LILACS databases, using the following descriptors: iron deficiency anemia, thalassemia minor, and differential diagnosis.

RESULTS

More than 40 mathematical indices based on erythrocyte parameters have been proposed in the hematological literature in individuals with microcytosis. Green & King indexes (IGK), Ehsani index, and erythrocyte count (RBC) had excellent performances, especially when their efficacy was observed in adults and children.

CONCLUSIONS

Confirmatory tests for differential diagnosis between IDA and TM require time-consuming and costly methods. Despite the excellent performances of IGK, Ehsani index, and RBC, none of them presented sufficient sensitivity and specificity to establish a diagnosis. However, they can provide a powerful additional tool for diagnostic simplification between IDA and TM.

Burden of moderate to severe anaemia and severe stunting in children < 3 years in conflict-hit Mount Cameroon: a community based descriptive cross-sectional study

BACKGROUND

Armed conflict is a significant social determinant of child health with nuanced effects. There is a dearth of knowledge on the public health issues facing vulnerable populations in conflict-stricken areas. The objective was to determine the prevalence and determinants of moderate to severe anaemia (MdSA) and severe stunting (SS) in children ≤3 years in conflict-hit Dibanda, Ekona and Muea in the Mount Cameroon area.

METHODS

Haematological parameters were obtained using an automated haematology analyser while undernutrition indices standard deviation (SD) scores (z- scores), were computed based on the WHO growth reference curves for 649 children in a community based cross-sectional study in 2018. Binomial logistic regression models were used to evaluate the determinants of MdSA and SS against a set of predictor variables.

RESULTS

Anaemia was prevalent in 84.0% (545) of the children with a majority having microcytic anaemia (59.3%). The prevalence of MdSA was 56.1% (364). Educational level of parents/caregiver (P <  0.001) and site (P = 0.043) had a significant negative effect on the occurrence of MdSA. Stunting, underweight and wasting occurred in 31.3, 13.1 and 6.3% of the children, respectively. Overall, SS was prevalent in 17.1% (111) of the children. The age groups (0.1-1.0 year, P = 0.042 and 1.1-2.0 years, P = 0.008), educational levels (no formal education, P <  0.001 and primary education P = 0.028) and SS (P = 0.035) were significant determinants of MdSA while MdSA (P = 0.035) was the only significant determinant of SS. On the contrary, age group 0.1-1 year (OR = 0.56, P = 0.043) and site (Dibanda, OR = 0.29, P = 0.001) demonstrated a significant protective effect against SS.

CONCLUSIONS

Moderate to severe anaemia, severe stunting and wasting especially in children not breastfed at all are public health challenges in the conflict-hit area. There is a need for targeted intervention to control anaemia as well as increased awareness of exclusive breast feeding in conflict-hit areas to limit the burden of wasting and stunting.

Classic and emergent indicators for the assessment of human iron status

Iron deficiency is the leading cause of anemia, a significant global public health problem. Different methods exist for assessing iron nutritional status, including laboratory tests that focus on storage, transportation, and iron functional compartment parameters. Classical markers such as bone marrow, serum iron, ferritin, hemoglobin, erythrocyte parameters, transferrin, transferrin receptors, and zinc protoporphyrin are discussed in this review. Additional parameters calculated from these indicators, including transferrin saturation, ferritin index and Thomas plot, and some emergent parameters such as hepcidin, erythroferrone, and low hemoglobin density are also discussed. There is no a single indicator for assessing iron nutritional status. Therefore, the use of more than one indicator may be the best practice to obtain the correct diagnosis, also considering the influence of inflammation/infection on many of these indicators. The constant validation of the current parameters, the improvement of assessment methods, and the identification of new indicators will be the key to refine the assessment of iron nutritional status and the right choice of treatment for its improvement.