The aim of this paper is to find microcytosis in donors, to establish prevalence of iron deficiency anaemia (IDA) and beta-thalassemia trait (BTT) in them and to evaluate which index is most effective in differentiating these two conditions. IDA and BTT are the most common causes of microcytic anaemia. Traditional approach is trial of iron treatment. Where thalassemias are common, this can lead to iron overload and failure to provide diagnosis/counselling in BTT. Initially 925 donor samples were evaluated on cell counter. Of these, 50 were found microcytic. These were subjected to Ferritin and HbA2 determination. Subsequently, additional 51, age- and sex-matched normocytic donor samples were selected as controls. These were subjected to the same tests. Nine indices namely RBC, RDW, Mentzer's, Shine and Lal, England and Fraser, Srivastava, Green and King, RDW index and Ricerca were used to differentiate IDA and BTT. Prevalence of microcytosis was 5.4%. Of these microcytic samples, 52% were IDA, 36% were BTT, 8% had both and 4% were undiagnosed. IDA had significantly lower Hb, mean corpuscular volume (MCV) and Ferritin levels than the control group. BTT had lower MCV, higher Ferritin and comparable Hb levels with control group. The Youden's index of Mentzer's was highest and RBC was the only index which had both sensitivity and specificity more than 80% for both IDA and BTT. It is desirable to routinely perform hemograms for all blood donors and further analyse the microcytic samples for Ferritin and HbA2 to diagnose IDA and BTT and to provide appropriate counselling/treatment.

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Background:The prevalence of microcytosis in donors and Iron Deficiency Anemia (IDA) and Beta-Thalassemia trait (BTT) in microcytic and non-microcytic donors has not been studied in India. The present study aims at finding the same.Materials and Methods:Initially 925 donor samples were evaluated on cell-counter. Of these, 50 were found to be microcytic. These were subjected to Ferritin and HbA2 determination. Subsequently, an additional 51, age-and-sex matched non-microcytic donor samples were selected to serve as controls. These were subjected to the same tests.Results:The prevalence of microcytosis was 5.4% (50/925). Among the microcytic donors, 52% were IDA, 36% BTT, 8% both, and 4% none. In case of non-microcytic donors 29.4% were IDA, 3.9% BTT, and 66.7% none.Conclusions:The study revealed a high prevalence of IDA and BTT in blood donors and a higher probability of finding these in the microcytic samples. This prompted authors to suggest an algorithm for screening of blood donors for IDA and BTT. The algorithm recommends doing an hemogram on all donor samples, routinely. Ferritin could be done only in microcytic samples. At levels lower than15 ng/ml, it is diagnosed as IDA, and therefore, HPLC is performed only for non-IDA samples with Ferritin levels higher than 15 ng/ml. By employing this algorithm, a substantial number of IDA and BTT could be diagnosed while keeping the number of Ferritin tests small and the number of HPLC tests even smaller and thus making it cost efficient.

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