The present study aimed to retrospectively evaluate the usefulness of cell counter-based parameters and formulas in beta-thalassemia trait (BTT) detection. The study included 170 BTT cases (hemoglobin [Hb]A(2) >4.0% [0.04]) and 30 non-BTT cases (HbA(2), 2.3%-3.5% [0.02-0.04]). Depending on the hemoglobin level and iron deficiency, the BTT group was further classified into classic BTT (n = 112) and BTT with iron deficiency anemia (n = 58). The RBC count, MCH, MCV, RDW, and Shine and Lal, Mentzler, Srivastava, England and Fraser, Ricerca, and Green indexes were applied. For the first time in the population of India, these 10 cell counter parameters and manual formulas were compared with high-performance liquid chromatography-derived HbA2 levels for deriving a cost-effective alternative method; and receiver operating characteristic curves were applied. We found that the Shine and Lal, Srivastava, and Mentzler indexes, MCV, and MCH have better discriminative function than the RBC count and red cell distribution width and their related formulas.

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Recently the Journal has published interesting articles and correspondence on the subject of the separation of thalassemia trait (TT) from iron deficiency anemia (IDA) by the use of RBC indices. Rathod et al 1 calculated 6 previously described indexes on 200 patients and correlated the findings with the findings of hemoglobin electrophoresis and iron studies. They favored the Shine and Lal index. 2 Harrington et al 3 used morphologic findings for the same purpose and, in the process, generated data showing red cell distribution width (RDW) to be a good discriminatory tool. Ntaios and Chatzinikolaou 4 criticized the use of RDW as a discriminator, having previously found it of little value.I believe it is usually easiest to separate TT and IDA by simple inspection, rather than using a mathematical index, using the following rules: (1) TT rarely causes anemia of less than 10 g/dL (100 g/L) of hemoglobin. (The hemoglobin value is usually more than 11 g/dL [110 g/L].) (2) The RBC count in TT is more than 5.0 × 10 6 /µL (5.0 × 10 12 /L) and in IDA is less than 5.0 × 10 6 /µL (5.0 × 10 12 /L). (3) The RDW in IDA is more than 17% and in TT is less than 17%.Discordances usually indicate a combined anemia. Here are a few illustrative true patient examples. (1) A 19-year-old woman was seen in the emergency department (ED) for a urinary tract infection. Her blood indices included the following: hemoglobin, 11.9 g/dL (119 g/L); mean corpuscular volume (MCV), 64.3 µm 3 (64.3 fL); RBC count, 5.77 × 10 6 /µL (5.77 × 10 12 /L); and RDW, 15.6%. All parameters indicate that she has TT, and there is no need for a hematologic workup. (2) A 37-year-old woman was seen in the ED for vaginal bleeding associated with uterine fibroids. Her blood indices included the following: CorrespondenCe Am J Clin Pathol 2009;131:444-445 445

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