Automated Measurement of Red Blood Cell Microcytosis and Hypochromia in Iron Deficiency and Beta Thalassemia Trait

Aims: To diagnose two most common causes of microcytosis in children by red cell indices which are easy to obtain, low cost parameters and an early detection of anaemia of childhood. Material and methods: 300 Infants and children aged (6 month to 18 years) of both sexes who presented with anaemia and their peripheral blood film revealed microcytic and hypochromic red cell picture were included in the study. Study duration was 12 months, from May 2005 to May 2006. A detailed clinical history was taken regarding the onset and duration of pallor symptoms and history of intake of haematinics was documented. Basic hematological parameters were performed using an automated analyzer. Mentzer index (MCV/red blood cell count) was used to differentiate thalassemia trait from iron deficiency. Serum iron was determined by autoanalyzer. Detailed picture of hemoglobin was obtained by Ion Exchange Liquid High Performance Liquid Chromatography. Results: It was observed that 31 patients were found to be with beta thalassemia while 269 patients were with iron deficiency anaemia. Mean Hb concentration, RBC count and serum iron level were significantly higher in traits than the iron deficient subjects (P<0.001). However the mean MCV was slightly lower in traits than the iron deficient subjects. Mentzer count ratio confirms the patients with iron deficiency or thalassemia trait. 31 cases with higher mean Hb concentration, higher mean red blood cell count and low mean red cell indices were selected and run chromatographically. All the cases showed a high HbA2 with a mean value 5.4%. On the other hand the range and mean values of HbF and of HbA was in normal limit. Conclusion: Percentage of children with beta thalassemia trait was less as compared to iron deficient children. However thalassemia centers sustain thousands of affected children with monthly blood transfusions. It is important to screen for beta thalassemia minor in the large number of population to stop the propagation of the gene.