Comparative analysis and predictive modeling of hematologic β-thalassemia minor in Pakistan: a cross-sectional study from 2019-2021

Authors

  • Aftab Ahmad Khan Department of Pathology and Research, Islamabad Diagnostic Center (IDC), Islamabad Pakistan
  • Rizwan Uppal Department of Pathology and Research, Islamabad Diagnostic Center (IDC), Islamabad Pakistan
  • Gul E Rehan Department of Pathology and Research, Islamabad Diagnostic Center (IDC), Islamabad Pakistan
  • Wardah Aslam Department of Pathology and Research, Islamabad Diagnostic Center (IDC), Islamabad Pakistan
  • Muhammad Rehan Uppal Department of Pathology and Research, Islamabad Diagnostic Center (IDC), Islamabad Pakistan
  • Umar Saeed Clinical and Biomedical Research Center (CBRC), Foundation University School of Health Sciences (FUSH), International Center of Medical Sciences Research (ICMSR), Islamabad

DOI:

https://doi.org/10.59736/IJP.21.04.874

Keywords:

Red cell parameters, Beta-thalassemia trait, Discriminative indices

Abstract

Background: Hypo chromic microcytic anemia happens to be the commonest form of anemia in Pakistan. Iron deficiency anemia (IDA) and Beta Thalassemia Trait (BTT) are its most common causes. Both are having similar clinical and laboratory findings. It is necessary to establish relevant cost-effective screening methods based on blood complete picture (CP) to predict BTT in order to reduce burden of Beta Thalassemia Major in Pakistani population.

Methods: A cross sectional study was conducted from 2019 to 2021. 10,739 BTT or IDA suspected subjects were recruited. Blood CP was done for each patient to analyze different red cell parameters like total red blood cell count (TRBC), hemoglobin (Hb), mean cell volume (MCV), mean cell hemoglobin(MCH), mean cell hemoglobin concentration(MCHC) and red cell distribution width(RDW). For serum ferritin level, serum was collected after centrifugation and analyzed by using Abbott Alinity chemistry analyzer.

Results: 1044 individuals had BTT and 270 were diagnosed as having IDA. Their RBC indices were analyzed using 25 formulae to differentiate between both conditions. Matos and Carvalho index and Pornprasert discriminative index appeared to be the most reliable indices with sensitivity, specificity, positive and negative predictive values, more than 98%.

Conclusion: By utilizing Matos and Carvalho index and Pornprasert index, we can cost effectively screen huge population for BTT

References

llah Z, Khattak AA, Ali SA, Hussain J, Noor B, Bano R, et al. Evaluation of five discriminating indexes to distinguish Beta-Thalassemia Trait from Iron Deficiency Anaemia. J Pak Med Assoc. 2016 Dec; 66(12):1627-31. PMID: 28179703.

Ahmad D, Ikram N, Bashir S, Yasin A. Discrimination Indices for Diagnosis of Beta (β) Thalassemia Trait. Journal of Rawalpindi Medical College. 2018 Mar 30; 22(1):18-21.

Jameel T, Baig M, Ahmed I, Hussain MB, bin Doghaim Alkhamaly M. Differentiation of beta thalassemia trait from iron deficiency anemia by hematological indices. Pakistan journal of medical sciences. 2017 May; 33(3):665.

Wickramaratne KA, Wijewickrama DC. Screening for beta-thalassemia trait; applicability of red cell indices and parameters–A study in Sri Lanka. International Journal of Health Sciences. 2021 Jan; 15(1):29-34.

Jahangiri M, Rahim F, Malehi AS. Diagnostic performance of hematological discrimination indices to discriminate between βeta thalassemia trait and iron deficiency anemia and using cluster analysis: Introducing two new indices tested in Iranian population. Scientific reports. 2019 Dec 9; 9(1):18610.

Düzenli Kar Y, Özdemir ZC, Emir B, Bör Ö. Erythrocyte indices as differential diagnostic biomarkers of iron deficiency anemia and thalassemia. Journal of Pediatric Hematology/Oncology. 2020 Apr 30; 42(3):208-13.

Hafeez Kandhro A, Shoombuatong W, Prachayasittikul V, Nuchnoi P. New bioinformatics-based discrimination formulas for differentiation of thalassemia traits from iron deficiency anemia. Laboratory medicine. 2017 Aug 1; 48(3):230-7.

Kumar A, Saha D, Kini J, Murali N, Chakraborti S, Adiga D. The role of discriminant functions in screening beta thalassemia trait and iron deficiency anemia among laboratory samples. Journal of Laboratory Physicians. 2017 Jul; 9(03):195-201.

Hassan K, Younus M, Ikram N, Naseem L, Zaheer HA. Red cell alloimmunization in repeatedly transfused thalassemia major patients. International Journal of pathology. 2018 Oct 23:16-9.

Mustafa A, Ali BA, Zulfiqar M, Naseem L. Role of discrimination indices in screening of beta thalassemia trait in low-resourced areas of Pakistan. National Journal of Health Sciences. 2019;4(1):21-4.

Muhammad R, Shakeel M, Rehman SU, Lodhi MA. Population-based genetic study of β-thalassemia mutations in Mardan Division, Khyber Pakhtunkhwa Province, Pakistan. Hemoglobin. 2017 Mar 4; 41(2):104-9.

El-Shanshory MR, Sherief LM, Hassab HM, Ragab SM, Yahia S, Mansour AK,et al. Prevalence of iron deficiency anemia and beta thalassemia carriers among relatives of beta thalassemia patients in Nile Delta region, Egypt: a multicenter study. Journal of the Egyptian Public Health Association. 2021 Dec; 96:1-8.

Susanah S, Sari NM, Prihatni D, Sinaga P, Trisaputra JO, Rakhmilla LE, Sribudiani Y. Extended family thalassemia screening as a feasible alternative method to be implemented in identifying carriers in West Java, Indonesia. Journal of Community Genetics. 2022 Feb; 13(1):103-12.

Shah FT, Sayani F, Trompeter S, Drasar E, Piga A. Challenges of blood transfusions in β-thalassemia. Blood reviews. 2019 Sep 1; 37:100588.

Al-Balushi AA, Al-Hinai B. Should premarital screening for blood disorders be an obligatory measure in Oman? Sultan Qaboos University Medical Journal. 2018 Feb; 18(1):e24.

Bouri S, Martin J. Investigation of iron deficiency anaemia. Clinical Medicine. 2018 Jun; 18(3):242-44.

Lee YK, Kim HJ, Lee K, Park SH, Song SH, Seong MW,etal. Recent progress in laboratory diagnosis of thalassemia and hemoglobinopathy: a study by the Korean Red Blood Cell Disorder Working Party of the Korean Society of Hematology. Blood research. 2019 Mar 31; 54(1):17-22. .

Matos JF, Dusse L, Borges KB, de Castro RL, Coura- Vital W, Carvalho MD. A new index to discriminate between iron deficiency anemia and thalassemia trait. Revista brasileira de hematologia e hemoterapia. 2016 Jul; 38:214-9.

Faraj SA, Ansaf AI, Mahdi LS. Value of the Matos and Carvalho index for thalassemia trait detection, experience of single hematological center in Iraq. Iraqi Journal of Hematology-Volume. 2019 Jul; 8(2):59.

Wickramaratne KA, Wijewickrama DC. Screening for beta-thalassemia trait; applicability of red cell indices and parameters–A study in Sri Lanka. International Journal of Health Sciences. 2021 Jan; 15(1):29.

Mukhopadhyay D, Saha K, Sengupta M, Mitra S, Datta C, Mitra PK. Role of discrimination indices in screening of beta-thalassemia trait in West Bengal, India: An institutional experience on 10,407 subjects. Saudi Journal for Health Sciences. 2015 Sep 1; 4(3):151-5.

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Published

2024-01-29

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Original article

How to Cite

1.
Khan AA. Comparative analysis and predictive modeling of hematologic β-thalassemia minor in Pakistan: a cross-sectional study from 2019-2021. Int J Pathol [Internet]. 2024 Jan. 29 [cited 2024 Dec. 26];21(4):126-30. Available from: https://jpathology.com/index.php/OJS/article/view/874

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