Demir eksikliği anemisi ve talasemi tanısında hematolojik indekslerin karşılaştırılması: Türkiye'de retrospektif bir çalışma

Yıl 2025, Cilt: 16 Sayı: 4, 440 - 448, 01.01.2026

Nuray Üremiş , Ergul Belge Kurutas , Medine Çitil

https://doi.org/10.18663/tjcl.1697505

Öz

Amaç: Demir eksikliği anemisi (DEA) ve beta-talasemi (β-TM) arasındaki doğru klinik ayrım, hastalık yönetimi ve etkili tedavi stratejilerinin belirlenmesi için kritik öneme sahiptir. Bu doğrultuda, bu çalışmada DEA ve talasemi arasındaki tanısal ayrım için kullanılan laboratuvar yöntemlerini ve hematolojik indeksleri karşılaştırmalı olarak değerlendirmeyi amaçladık. Çalışmada, DEA ve talaseminin rutin biyokimya analizleri arasındaki farklar ve bu hastalıkların teşhisinde kullanılan sekiz farklı indeksin etkinliği incelenmiştir.
Gereç ve Yöntemler: DEA ve β-TM Minör tanısı alan hastaların rutin hematolojik parametreleri retrospektif olarak analiz edildi. Menzier İndeksi (MI), Green and King İndeksi (G&K), England and Fraser İndeksi (E&F), Kırmızı Kan Hücresi Dağılım Genişliği İndeksi (RDWI), Ricarca İndeksi (RI), Srivastava İndeksi (S), Sirdah İndeksi (SI) ve Ehsani İndeksi hesaplandı ve tanısal etkinlikleri değerlendirildi.
Bulgular: Sekiz ayrım indeksi değerlendirildiğinde, G&K ve E&F indeksleri IDA ve β-TM'yi ayırt etmede en etkili indekslerdi. Bu indeksler sırasıyla %81,41 ve %80,24 Youden indeks değerleri ile yüksek duyarlılık ve özgüllük oranları gösterdi. Diğer ayırıcı indeksin karşılaştırmalı değerlendirmesi sonucunda, IDA ile β-TM’nin ayırt edilmesinde tanısal performans sırası G&K > E&F > SI > RDWI > RI > MI > E > S > RBC olarak saptanmıştır.
Sonuç: Çeşitli hematolojik indekslerin kullanılması DEA ve β-TM ayrımında tanısal doğruluğu artırmaktadır. Özellikle G&K ve E&F indeksleri doğru tanıyı kolaylaştırabilir ve daha etkili klinik yönetim süreçlerine olanak sağlayabilir.

Anahtar Kelimeler

Demir eksikliği anemisi , beta-talasemi , hematolojik indeks , kırmızı kan hücresi indeksleri , eritrosit parametreleri

Etik Beyan

Çalışma, Kahramanmaraş Sütçü İmam Üniversitesi Tıp Araştırmaları Etik Kurulu tarafından 2025/05-388 protokol numarasıyla onaylanmıştır.

Comparison of haematological indices in diagnosing iron deficiency anaemia and thalassaemia: a retrospective study in Turkey

Öz

Aim: Accurate clinical differentiation between Iron Deficiency Anemia (IDA) and beta-thalassemia (β-TM) is critical for disease management and the determination of effective treatment strategies. Accordingly, in this study, we aimed to comparatively evaluate the laboratory methods and hematologic indices used for the diagnostic differentiation between IDA and thalassemia. The study examined the differences between routine biochemistry analyses of IDA and thalassemia and the effectiveness of eight different indices used to diagnose these diseases.
Material and Methods: Routine hematological parameters of patients diagnosed with IDA and β-TM Minor were analyzed retrospectively. Menzier Index (MI), Green and King Index (G&K), England and Fraser Index (E&F), Red Blood Cell Distribution Width Index (RDWI), Ricarca Index (RI), Srivastava Index (S), Sirdah Index (SI), and Ehsani Index were calculated and their diagnostic efficiency was evaluated.
Results: When eight discrimination indices were evaluated, G&K and E&F indices were the most effective in differentiating IDA and β-TM. These indices showed high sensitivity and specificity rates with Youden index values of 81.41% and 80.24%, respectively. As a result of the comparative evaluation of other discriminatory indices, the diagnostic performance order for distinguishing between IDA and β-TM was determined to be G&K > E&F > SI > RDWI > RI > MI > E > S > RBC.
Conclusion: Using various hematologic indices increases the diagnostic accuracy in differentiating IDA and β-TM. In particular, G&K and E&F indices may facilitate accurate diagnosis and enable more effective clinical management processes.

Anahtar Kelimeler

Iron deficiency anemia , beta-thalassemia , hematologic index , red blood cell indices , erythrocyte parameters

Etik Beyan

The study was approved by Kahramanmaraş Sütçü İmam University Medical Research Ethics Committee with protocol number 2025/05-388.

Kaynakça

• Rund D, Rachmilewitz E. Beta-thalassemia. N Engl J Med. 2005; 353: 1135–46.
• Williams TN, Weatherall DJ. World distribution, population genetics, and health burden of the hemoglobinopathies. Cold Spring Harb Perspect Med. 2012; 2: a011692.
• Huang TL, Zhang TY, Song CY, Wang Y, Li Q, Liu J, et al. Gene Mutation Spectrum of Thalassemia Among Children in Yunnan Province. Front Pediatr. 2020; 8: 159.
• Lai K, Huang G, Su L, He Y. The prevalence of thalassemia in mainland China: evidence from epidemiological surveys. Sci Rep. 2017; 7: 920.
• Tuo Y, Li Y, Li Y, Zhang M, Wei F, Chen Y, et al. Global, regional, and national burden of thalassemia, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. EClinicalMedicine. 2024; 72: 102619.
• Brancaleoni V, Di Pierro E, Motta I, Cappellini MD. Laboratory diagnosis of thalassemia. Int J Lab Hematol. 2016; 38(Suppl 1): 32–40.
• Sun A, Chang JY, Jin YT, Chiang CP. Differential diagnosis between iron deficiency anemia and thalassemia trait-induced anemia. J Dent Sci. 2023; 18: 1963–4.
• Angastiniotis M, Eleftheriou A, Galanello R, Modell B, Petrou M, Old J, et al. In: Old J, editor. Prevention of Thalassaemias and Other Haemoglobin Disorders: Volume 1: Principles. Nicosia (Cyprus); 2013.
• Old J, Harteveld CL, Traeger-Synodinos J, Petrou M, Angastiniotis M, Galanello R. Prevention of Thalassaemias and Other Haemoglobin Disorders: Volume 2: Laboratory Protocols. Nicosia (Cyprus); 2012.
• Usman M, Moinuddin M, Ahmed SA. Role of iron deficiency anemia in the propagation of beta thalassemia gene. Korean J Hematol. 2011; 46: 41–4.
• Uzuncan N, Bilgili S, Sezen A, Ahin, Bozkaya G. Iron Deficiency Anemia and β-Thalassemia Minor Differentiation With Hematological Indices. 2019.
• Saleem M, Aslam W, Lali MIU, Rauf HT, Nasr EA. Predicting Thalassemia Using Feature Selection Techniques: A Comparative Analysis. Diagnostics. 2023; 13: 3441.
• Algiraigri AH. Premarital Screening for Hemoglobinopathies: Can We Do Better? J Appl Hematol. 2021; 12: 101–4.
• Aleem A, Alsayegh F, Keshav S, Aljefri H, Khan A, Alhazmi A, et al. Consensus Statement by an Expert Panel on the Diagnosis and Management of Iron Deficiency Anemia in the Gulf Cooperation Council Countries. Med Princ Pract. 2020; 29: 371–81.
• Vehapoglu A, Ozgurhan G, Demir AD, Turkmen S, Cetin E, Basar H, et al. Hematological indices for differential diagnosis of Beta thalassemia trait and iron deficiency anemia. Anemia. 2014; 2014: 576738.
• Okan V, Cigiloglu A, Cifci S, Yilmaz M, Pehlivan M. Red cell indices and functions differentiating patients with the beta-thalassaemia trait from those with iron deficiency anaemia. J Int Med Res. 2009; 37: 25–30.
• Rahim F, Kazemnejad A, Jahangiri M, Malehi AS, Gohari K. Diagnostic performance of classification trees and hematological functions in hematologic disorders: an application of multidimensional scaling and cluster analysis. BMC Med Inform Decis Mak. 2021; 21: 313.
• Rastogi N, Bhake AS. Sehgal index and its comparison with Mentzer's index and Green and King index in assessment of peripheral blood smear with marked anisopoikilocytosis. Int J Res Med Sci. 2020; 8: 2244-8.
• Demir A, Yarali N, Fisgin T, Duru F, Kara A. Most reliable indices in differentiation between thalassemia trait and iron deficiency anemia. Pediatr Int. 2002; 44: 612–6.
• Sirdah M, Tarazi I, Al Najjar E, Al Haddad R. Evaluation of the diagnostic reliability of different RBC indices and formulas in the differentiation of the beta-thalassaemia minor from iron deficiency in Palestinian population. Int J Lab Hematol. 2008; 30: 324–30.
• Bhargava M, Kumar V, Pandey H, Singh V, Misra V, Gupta P. Role of Hematological Indices as a Screening Tool of Beta Thalassemia Trait in Eastern Uttar Pradesh: An Institutional Study. Indian J Hematol Blood Transfus. 2020; 36: 719–24.
• Balcázar-Villarroel M, Mancilla-Uribe A, Navia-León S, Carmine F, Birditt K, Sandoval C. Diagnostic Performance of Red Blood Cell Indices in the Differential Diagnosis of Iron Deficiency Anemia and the Thalassemia Trait in Chile: A Retrospective Study. Diagnostics. 2024; 14: 2353.
• Matos JF, Dusse LMSA, Stubbert RVB, Carvalho MD, Figueiredo RC, Silva JF, et al. Comparison of discriminative indices for iron deficiency anemia and β thalassemia trait in a Brazilian population. Hematology. 2013; 18: 169–74.
• Tari K, Atashi A, Karami F, Kiani Nodeh F, Shahjahani M. Evaluation of the Formulae Based on Red Blood Cell Indices in Differentiating Between Iron Deficiency Anemia and Beta Thalassemia Minor. Int J Med Lab. 2015; 2: 188–93.
• Ahmed HA, Khaled SAA, Fahmy EM, Mohammed NA, Mahmoud HFF. Significance of the mathematically calculated red cell indices in patients with qualitative and quantitative hemoglobinopathies. Egypt J Intern Med. 2022; 34: 60.
• Schisterman EF, Faraggi D, Reiser B, Hu J. Youden Index and the optimal threshold for markers with mass at zero. Stat Med. 2008; 27: 297–316.
• Jahangiri M, Rahim F, Malehi AS. Diagnostic performance of hematological discrimination indices to discriminate between βeta thalassemia trait and iron deficiency anemia and using cluster analysis: Introducing two new indices tested in Iranian population. Sci Rep. 2019; 9: 18610.
• Düzenli Kar Y, Özdemir ZC, Emir B, Bör Ö. Erythrocyte Indices as Differential Diagnostic Biomarkers of Iron Deficiency Anemia and Thalassemia. J Pediatr Hematol Oncol. 2020; 42: 208–13.
• Althumairi A, AlQarni AM, Alkaltham NK, Almutairi AA, AlOtaibi AS, Alharbi SH, et al. Diagnostic test performance of the Mentzer index in evaluating Saudi children with microcytosis. Front Med (Lausanne). 2024; 11: 1361805.
• Jameel T, Baig M, Ahmed I, Hussain MB, Alkhamaly MBD. Differentiation of beta thalassemia trait from iron deficiency anemia by hematological indices. Pak J Med Sci. 2017; 33: 665–9.
• AlFadhli SM, Al-Awadhi AM, AlKhaldi DA. Validity Assessment of Nine Discriminant Functions Used for the Differentiation between Iron Deficiency Anemia and Thalassemia Minor. J Trop Pediatr. 2006; 53: 93–7.