Discrimination of beta-thalassemia minor and iron deficiency anemia by screening test for red blood cell indices

Aim: To assess the state of iron deficiency anemia and thalassemia minor among couples intending to marry at the Molla Hadi Sabzevari Health Clinic in Isfahan, Iran. Materials and methods: Couples who intend to marry have to undergo these tests as part of a compulsory countrywide program. In this study, the red blood cell (RBC) indices among the study population were measured with an electronic cell counter (Sysmex K800). The survey involved the measurement of 2 RBC indices, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH), and the results were compared with the England and Fraser, Shine and Lal, and Mentzer indices. Results: The study population included 11,900 individuals, of whom 901 were recognized as having hypochromia (MCH < 32 pg/cell) and microcytosis (MCV < 80 fL). Of these 901 persons, 444 had developed beta-thalassemia, and 457 had iron deficiency anemia or were affected by other causes of microcytosis and hypochromia. Conclusion: RBC indices and 3 other index components were examined with the screening test. The screening precision was based on the cut-off point of the hemoglobin A2 scale detected by column chromatography, or by DNA amplification by polymerase chain reaction. The findings reveal that the England and Fraser index, with a sensitivity level of 87.2%, is an acceptable discriminator of thalassemic and nonthalassemic patients. All indices functioned more accurately for men than for women.