title: Reticulocyte hemoglobin equivalent to detect thalassemia and thalassemic hemoglobin variants.
abstract: BACKGROUND
  Thalassemia and iron deficiency may both result in hypochromic microcytic anemia. Hematological algorithms that differentiate the two are mainly established in adult selected diagnostic groups. We aimed at creating an algorithm applicable in the presence of children, hemoglobin variants, and iron deficiency.
  
  
  METHODS
  Our study material constituted blood samples referred during 1 year for routine diagnostics of hemoglobinopathy. We included 443 samples, of which 37% were from children 3 months or older. We found β-thalassemia trait (n = 100), α-thalassemia (n = 75), combined α-/β-thalassemia (n = 14), hemoglobin variants (n = 42), and no-hemoglobinopathy (n = 207), of whom 107 had a ferritin at or below 20 μg/L. We included reticulocyte hemoglobin equivalent, ferritin, and erythrocyte count in our algorithm.
  
  
  RESULTS
  Our algorithm differentiated β-thalassemia trait from no-hemoglobinopathy with a sensitivity of 99% at 83% specificity. It performed better than other published algorithms when applied to all patient samples, while equally or moderately better in the 63% adult samples. Our algorithm also detected the clinically significant α-thalassemias, and most of the combined α-/β-thalassemias and thalassemic hemoglobin variants.
  
  
  CONCLUSIONS
  Our algorithm efficiently differentiated thalassemia and thalassemic hemoglobin variants from iron deficiency in children and adults.
authors: Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway.
authors: Å A
authors: ÅA
authors: Sudmann
authors: Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway.|Fürst Medical Laboratory, Oslo, Norway.
authors: A
authors: A
authors: Piehler
authors: Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway.
authors: P
authors: P
authors: Urdal
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D002851:Chromatography, High Pressure Liquid; D004909:Erythrocyte Indices; D005260:Female; D005293:Ferritins / Q000032:analysis; D005914:Globins / Q000235:genetics; D006453:Hemoglobinopathies / Q000097:blood* / Q000175:diagnosis / Q000235:genetics; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007223:Infant; D008297:Male; D012372:ROC Curve; D015203:Reproducibility of Results; D012156:Reticulocytes / Q000378:metabolism*; D017422:Sequence Analysis, DNA; D055815:Young Adult; D017085:alpha-Thalassemia / Q000097:blood* / Q000175:diagnosis / Q000235:genetics; D017086:beta-Thalassemia / Q000097:blood* / Q000175:diagnosis / Q000235:genetics
chemical_list: D006454:Hemoglobins; D005914:Globins; D005293:Ferritins