Abstract
Although the discrimination between β-thalassemia trait (βTT) and Iron deficiency anemia (IDA) is important clinically, but it is challenging and normally difficult; so if a patient with IDA is diagnosed as βTT, then it is deprived of iron therapy. This study purpose was to evaluate the 26 different discriminating indices diagnostic function in patients with microcytic anemia by using accuracy measures, and also recommending two distinct new discriminating indices as well. In this study, 907 patients were enrolled with the ages over 18-year-old with either βTT or IDA. Twenty-six discrimination indices diagnostic performance presented in earlier studies, and two new indices were introduced in this study (CRUISE index and index26) in order to evaluate the differential between βTT and IDA by using accuracy measures. 537 (59%) patients with βTT (299 (56%) women, and 238 (44%) men), and also 370 (41%) patients with IDA (293 (79%) women, and 77 (21%) men) were participated in this study for evaluating the 28 discrimination indices diagnostic performance. Two new introduced indices (CRUISE index and index26) have better performance than some discrimination indices. Indices with the amount of AUC higher than 0.8 had very appropriate diagnostic accuracy in discrimination between βTT and IDA, and also CRUISE index has good diagnostic accuracy, too. The present study was also the first cluster analysis application in order to identify the homogeneous subgroups of different indices with similar diagnostic function. In addition, new indices that offered in this study have presented a relatively closed diagnostic performance by using cluster analysis for the different indices described in earlier studies. Thus, we suggest the using of cluster analysis in order to determine differential indices with similar diagnostic performances.
Highlights
The discrimination between β-thalassemia trait and Iron deficiency anemia (IDA) is important clinically, but it is challenging and normally difficult; so if a patient with IDA is diagnosed as βTT, it is deprived of iron therapy
This cross-sectional study was conducted on Iranian patients diagnosed to have βTT and IDA
Two new discriminating indices were proposed for differentiating between the βTT and IDA, and these indices presented a relatively similar diagnostic performance according to cluster analysis compared to different indices reported in the literature
Summary
The discrimination between β-thalassemia trait (βTT) and Iron deficiency anemia (IDA) is important clinically, but it is challenging and normally difficult; so if a patient with IDA is diagnosed as βTT, it is deprived of iron therapy. This study purpose was to evaluate the 26 different discriminating indices diagnostic function in patients with microcytic anemia by using accuracy measures, and recommending two distinct new discriminating indices as well. Twenty-six discrimination indices diagnostic performance presented in earlier studies, and two new indices were introduced in this study (CRUISE index and index26) in order to evaluate the differential between βTT and IDA by using accuracy measures. The present study was the first cluster analysis application in order to identify the homogeneous subgroups of different indices with similar diagnostic function. Because the definitive diagnosis between βTT and IDA is confirmed by performing blood tests in order to measure the HbA2, serum iron, serum ferritin, transferrin saturation, and total iron binding capacity (TIBC), and these parameters are typically considered as the gold standards for discriminating between these two hematologic disorders[9,14,15,16,17,18]
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