title: Indices used in differentiation of thalassemia trait from iron deficiency anemia in pediatric population: are they reliable?
abstract: BACKGROUND
  Iron deficiency (IDA) and beta thalassemia trait (TT) are the most common causes of hypochromia and microcytosis. Many indices have been defined to quickly discriminate these similar entities via parameters obtained from automated blood cell analyzers. However, studies in the pediatric age group are scarce and their results are controversial.
  
  
  METHODS
  We calculated eight discrimination indices [Mentzer Index (MI), England and Fraser Index (E&F), Srivastava Index (S), Green and King Index (G&K), Shine and Lal Index (S&L), red blood cell (RBC) count, RBC distribution width, and red blood cell distribution width Index (RDWI)] in 100 patients. We calculated sensitivity (SENS), specificity (SPEC), positive and negative predictive value (PPV and NPV), and Youden's Index (YI) of each discrimination index.
  
  
  RESULTS
  None of the discrimination indices showed a SENS and SPEC of 100%. The highest SENS was obtained with S&L (87.1%), while the highest SPEC was obtained with E&F formula (100%). The highest YI value was obtained with E&F formula (58.1%).
  
  
  CONCLUSIONS
  In our study, none of the formulas appears reliable in discriminating between TT and IDA patients. The evaluation of iron status and measurement of hemoglobin A(2) (HbA(2)) remain the most reliable investigations to differentiate between TT and IDA patients.
authors.affiliation: Department of Pediatrics, Namik Kemal University, Tekirdag, Turkey. bnalbantoglu@nku.edu.tr
authors.forename: Burçin
authors.initials: B
authors.lastname: Nalbantoğlu
authors.forename: Savaş
authors.initials: S
authors.lastname: Güzel
authors.forename: Volkan
authors.initials: V
authors.lastname: Büyükyalçın
authors.forename: M Metin
authors.initials: MM
authors.lastname: Donma
authors.forename: Eda Çelik
authors.initials: EÇ
authors.lastname: Güzel
authors.forename: Ayşin
authors.initials: A
authors.lastname: Nalbantoğlu
authors.forename: Erkut
authors.initials: E
authors.lastname: Karasu
authors.forename: Burcu
authors.initials: B
authors.lastname: Özdilek
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood* / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006443:Hemoglobin A2 / Q000378:metabolism*; D006801:Humans; D007501:Iron / Q000097:blood*; D008297:Male; D012189:Retrospective Studies; D017086:beta-Thalassemia / Q000097:blood* / Q000175:diagnosis*
chemical_list: D006443:Hemoglobin A2; D007501:Iron