title: Discrimination index of microcytic anemia in young soldiers: a single institutional analysis.
abstract: BACKGROUND
  The common differential diagnosis of microcytic anemia in young Asian men includes iron deficiency anemia (IDA), α-thalassemia (αT) and β-thalassemia (βT). In this study, we aimed to distinguish between these diseases in a distinct population of young men using a specific index.
  
  
  METHODS
  We retrospectively reviewed the laboratory data of young men with microcytic anemia. The clinical, characteristic and laboratory data, including complete blood cell counts, serum ferritin and hemoglobin electrophoresis results, were collected; genomic DNA mutations were also evaluated. Based on these data, ten discrimination indices were used to differentiate thalassemia from IDA. The sensitivity, specificity, positive and negative predictive values, Youden's index and receiver operating characteristic (ROC) curves were also calculated.
  
  
  RESULTS
  A total of 877 patients (92 patients with IDA, 332 with αT and 453 with βT) were enrolled; the Shine and Lal (S&L) formula was the best method with which to discriminate IDA from thalassemia (100% sensitivity, 91% specificity). The new cut-off values were evaluated, and the approaches used in our study cohort, particularly the Green & King (G&K) formula, significantly increased the accuracies of red cell distribution width-containing indices (cut-off value: 58.66; 89.62% sensitivity and 96.2% specificity; AUC: 0.9716). In addition, when applied properly, these indices could differentiate IDA patients from αT patients, especially Huber-Herklotz index (HH).
  
  
  CONCLUSIONS
  The sensitivity and specificity differed among ethnic and age groups. We concluded that when using the original cut-off value, the S&L formula was the best discriminating index for differentiating between IDA and thalassemia in young Asian men. However, when using the G&K formula, the newly obtained cut-off value must be applied to increase accuracy based on the results from our cohort.
authors: Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan.
authors: Tzu-Chuan
authors: TC
authors: Huang
authors: Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
authors: Yi-Ying
authors: YY
authors: Wu
authors: Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan.
authors: Yu-Guang
authors: YG
authors: Chen
authors: Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan.
authors: Shiue-Wei
authors: SW
authors: Lai
authors: Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan.
authors: Sheng-Cheng
authors: SC
authors: Wu
authors: Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan.
authors: Ren-Hua
authors: RH
authors: Ye
authors: Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan.
authors: Chieh-Sheng
authors: CS
authors: Lu
authors: Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Jia-Hong
authors: JH
authors: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000097:blood / Q000175:diagnosis*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel; D012189:Retrospective Studies; D055815:Young Adult