The value of the red cell distribution width index versus other parameters in the differentiation between iron deficiency anemia and beta thalassemia trait among children in Mosul, Iraq

Al-Numan, Aws H.; Al-Obeidi, Riyadh Abdulatif

doi:10.1080/17474086.2021.1905514

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…34 Moreover, it has also been proposed that the RBC distribution width index (MCV/RBC × RBC distribution width) has better distinguishing ability between β-TT and IDA than other parameters, including RBC count and RBC distribution width, in children from Iraq. 35 However, the conditions of TT and parameters of RBC According to previous studies, α-TT and β-TT are prevalent in Fujian Province. 30 Therefore, this study enrolled both patients…”

Section: Discussionmentioning

confidence: 99%

“…Another study evaluated the capability of optical RBC technology for discriminating patients with β‐TT and IDA and revealed that the RBC concentration has the best discriminative value with an AUC of 0.963, followed by the RBC distribution width in the size distribution with an AUC of 0.960 and the RBC distribution width coefficient of variation with an AUC of 0.924 34 . Moreover, it has also been proposed that the RBC distribution width index (MCV/RBC × RBC distribution width) has better distinguishing ability between β‐TT and IDA than other parameters, including RBC count and RBC distribution width, in children from Iraq 35 . However, the conditions of TT and parameters of RBC are highly heterogeneous regionally and ethnically.…”

Section: Discussionmentioning

confidence: 99%

“… 34 Moreover, it has also been proposed that the RBC distribution width index (MCV/RBC × RBC distribution width) has better distinguishing ability between β‐TT and IDA than other parameters, including RBC count and RBC distribution width, in children from Iraq. 35 However, the conditions of TT and parameters of RBC are highly heterogeneous regionally and ethnically. Therefore, the differential indices with good performance reported by previous studies might not work in people of other regions or ethnicities.…”

Section: Discussionmentioning

confidence: 99%

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Logistic‐Nomogram model based on red blood cell parameters to differentiate thalassemia trait and iron deficiency anemia in southern region of Fujian Province, China

Xu¹,

Ge²,

Dong³

et al. 2023

Clinical Laboratory Analysis

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BackgroundDifferentiation between thalassemia trait (TT) and iron deficiency anemia (IDA) is challenging and costly. This study aimed to construct and evaluate a model based on red blood cell (RBC) parameters to differentiate TT and IDA in the southern region of Fujian Province, China.MethodsRBC parameters of 364 TT patients and 316 IDA patients were reviewed. RBC parameter‐based Logistic‐Nomogram model to differentiate between TT and IDA was constructed by multivariate logistic regression analysis plus nomogram, and then compared with 22 previously reported differential indices.ResultsThe patients were randomly selected to a training cohort (nTT = 248, nIDA = 223) and a validation cohort (nTT = 116, nIDA = 93). In the training cohort, multivariate logistic regression analysis identified RBC count, mean corpuscular hemoglobin (MCH), and MCH concentration (MCHC) as independent parameters associated with TT susceptibility. A nomogram was plotted based on these parameters, and then the RBC parameter‐based Logistic‐Nomogram model g (μy) = 1.92 × RBC count‐0.51 × MCH + 0.14 × MCHC‐39.2 was devised. The area under the curve (AUC) (95% CI) was 0.95 (0.93–0.97); sensitivity and specificity at the best cutoff score (120.24) were 0.93 and 0.89, respectively; the accuracy was 0.91. In the validation cohort, the RBC parameter‐based Logistic‐Nomogram model had AUC (95% CI) of 0.95 (0.91–0.98); sensitivity and specificity were 0.92 and 0.87, respectively; accuracy was 0.90. Moreover, compared with 22 reported differential indices, the RBC parameter‐based Logistic‐Nomogram model showed numerically higher AUC, net reclassification index, and integrated discrimination index (all p < 0.001).ConclusionThe RBC parameter‐based Logistic‐Nomogram model shows high performance in differentiating patients with TT and IDA from the southern region of Fujian Province.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Logistic‐Nomogram model based on red blood cell parameters to differentiate thalassemia trait and iron deficiency anemia in southern region of Fujian Province, China

Xu¹,

Ge²,

Dong³

et al. 2023

Clinical Laboratory Analysis

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“…[4][5][6][7][8][9][10][11][12][13][14][15] Most studies evaluating the efficiency of various erythrocyte indices in discriminating between IDA and BTT have been conducted in adults, and data in children are scarce. [16][17][18][19][20][21][22][23][24][25][26] We aimed to evaluate the reliability of 12 erythrocyte indices in the differential diagnosis between IDA and BTT in children with HMA.…”

Section: Introductionmentioning

confidence: 99%

Validity of Erythrocyte Indices in Differentiation between Iron Deficiency Anemia and β-Thalassemia Trait in Children

Uzunoğlu,

Yılmaz Keskin

2024

JPA

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Iron deficiency anemia (IDA) and β-thalassemia trait (BTT) are the most common causes of hypochromic microcytic anemia (HMA). Various erythrocyte indices that may help in the initial discrimination between IDA and BTT have been reported, but data evaluating their reliability in children are scarce. We aimed to evaluate the validity of 12 erythrocyte indices in the differentiation between IDA and BTT in children. These indices were red blood cell (RBC) count, Mentzer Index, England and Fraser Index, Srivastava Index, Shine and Lal Index, RBC distribution width (RDW), Ricerca Index, Green and King Index, RDW Index, Sirdah Index, Ehsani Index, and Serdar Index. Among 1,444 children with HMA, 136 (9.4%) were stratified into the IDA group and 137 (9.5%) into the BTT group. Of the 12 indices, the Green and King Index showed the highest reliability, as it had the highest Youden’s index (75.1%). Its sensitivity, specificity, positive predictive value, negative predictive value and correct diagnosis rate were 92.7%, 82.4%, 84.1%, 91.8% and 87.5%, respectively. The second most reliable index was the RDW Index, having a Youden’s index, sensitivity, specificity, positive predictive value, negative predictive value and correct diagnosis rate of 64.0%, 94.2%, 69.9%, 75.9%, 92.2% and 82.0%, respectively. Receiver operating characteristic analysis showed that the revised cut-off values for the Green and King Index and RDW Index had higher sensitivity and specificity levels than the cut-off values commonly used in the literature. The findings of this study suggest the superiority of the Green and King Index and the RDW Index as screening tools in the initial differentiation between IDA and BTT among children with HMA.

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“…Several empirical studies have demonstrated significant elevation in RDW values in the presence of sickle cell and thalassemia disorders and the potential of this hematological parameter to distinguish hemoglobinopathy cases from other hematological disorders. Some of these investigated uses of RDW to distinguish thalassemia from iron deficiency anemia [20][21][22][23][24][25], while others demonstrate the potential of RDW to serve as laboratory biomarkers for discriminating bearers of sickle cell Hb (HbSS and HbAS) and thalassemia from those with other hematological disorders [26,27]. The currently documented normal value for RDW (CV) is 11-14.5% [13].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Potential of RDW in Discriminating Hemoglobinopathies among Patients reporting to Aga Khan Hospital, Kisumu

Mutua

Sowayi

Okoth

2022

Egypt J Med Hum Genet

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Background Red cell distribution width (RDW) measures the extent of variation in red blood cell (RBC) volume in terms of coefficient of variation. It reflects the degree of variation in RBC’s sizes and shapes, characteristic of iron deficiency and anemias involving RBC destruction, especially hemoglobinopathies. Its values are often available as one of the RBC indices generated as complete blood cell count (CBC) using automated hematology analyzers. Hemoglobinopathies are highly prevalent in malaria-endemic geographical settings like the Sub-Saharan African which has over 200,000 currently documented annual major hemoglobinopathies with an alarming mortality rate of 50–90% by the age of 5 years usually undiagnosed. With a vast growing majority of hemoglobinopathy carriers, this public health problem is projected to escalate by the year 2050 due to unaffordable laboratory tests for screening of newborns and populations as recommended by World Health Organization in resource-limited settings. Therefore, innovative of a cost-effective diagnostic method would improve the survival of these children. The current study aimed to evaluate the overall ability of RDW in discriminating hemoglobinopathy and hemoglobinopathy-free cases within the Lake Victoria Economic Block region of Western Kenya served partly by the Aga Khan Hospital, Kisumu. Objective To determine the significance of RDW as a tool to differentiate between individuals with hemoglobinopathies and those without. Method This was a cross-sectional retrospective comparative hospital-based study that analyzed data from the hematology laboratory database for patients examined using high-performance liquid chromatography during the years 2015–2020. The study consisted of 488 participants (49.4%, n = 241 control; 50.6% n = 247 case, p = 0.786) aged between 1 month and 66 years selected conveniently through census. The relationship between RDW of the controls and cases was analyzed using Mann–Whitney U, Kruskal–Wallis tests among population groups and Dunn’s post hoc test within groups since the data were non-normally distributed. Results The RDW cutoff value was computed at 95% confidence interval (CI), and values greater than this indicated a diagnosis of hemoglobinopathy. Conclusion RDW at 95% CI was 19.9 [14.5 + (2.7 × 2 = 19.9)] cutoff point which proved to be an excellent screening tool for sickle cell disease phenotypes in Western Kenya but would generate many false positive and false negatives for pure Hb AS. RDW is a poor screening tool for, Hb AS + HbF, Hb AS + β thal and β-thalassemia since it could not differentiate diseased from non-diseases populations. Even though RDW proved to be a poor screening tool for beta thalassemia, other complete blood count (CBC) parameters such as MCV and red cell count can be used to identify thalassemia syndromes as well as iron deficiency anemia. Though out of the scope of this work, highlighting the significance of these parameters in addition to the RDW would improve its feasibility as a screening tool for all hemoglobinopathies. Normal reference range for children ≤ 5 years needs to be developed using prospective data for precise marking of disorders associated with red cell anisocytosis, and individuals ≥ 6 years can share RDW normal reference range regardless of their gender.

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The value of the red cell distribution width index versus other parameters in the differentiation between iron deficiency anemia and beta thalassemia trait among children in Mosul, Iraq

Cited by 8 publications

References 25 publications

Logistic‐Nomogram model based on red blood cell parameters to differentiate thalassemia trait and iron deficiency anemia in southern region of Fujian Province, China

Logistic‐Nomogram model based on red blood cell parameters to differentiate thalassemia trait and iron deficiency anemia in southern region of Fujian Province, China

Validity of Erythrocyte Indices in Differentiation between Iron Deficiency Anemia and β-Thalassemia Trait in Children

Prognostic Potential of RDW in Discriminating Hemoglobinopathies among Patients reporting to Aga Khan Hospital, Kisumu

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