Hemin-Loaded Nanoparticles Improve Iron Supplementation and Gut Microbiota Balance in Iron-Deficiency Anemia Therapy.

Observational studies suggest that there are associations among gut microbiota, disorders of gut-brain interaction (DGBIs) and psychiatric disorders. Therefore, the aim of this study was to use Mendelian randomization (MR) to systematically identify the causality of the associations among the abundances of several gut microbiota and the risk of developing DGBIs and psychiatric disorders. Genetic data associated with gut microbiota, DGBIs, and psychiatric disorders were obtained from large-scale genome-wide association studies (GWASs). Inverse-variance weighting, MR-Egger, and weighted median methods were used to examine causal associations. The sensitivity analyses were conducted via the MR-Egger intercept test, Cochran's Q test, MR-pleiotropy residual sum and outlier (MR-PRESSO) test, leave-one-out analysis, and funnel plots. Reverse-MR analysis was performed to evaluate the possibility of reverse causation. Finally, we used MR mediation analysis to explore potential mediators of the causal associations among the abundances of gut microbiota and the risk of developing DGBIs and psychiatric disorders. Our MR analysis revealed 44 causal relationships between the abundances of several gut microbiota and the risk of developing DGBIs and 66 causal relationships between the abundances of several gut microbiota and the risk of developing psychiatric disorders. In addition, in the reverse-MR analysis, 15 causal relationships between the risk of developing DGBIs and the abundances of several gut microbiota and 47 causal relationships between the risk of developing psychiatric disorders and the abundances of several gut microbiota were explored. Our results showed that the abundances of some microbiota and their child taxa might be closely associated with the risk of developing certain diseases. Moreover, we observed one causal relationship between the risk of developing DGBIs and the risk of developing psychiatric disorders and 7 causal relationships between the risk of developing psychiatric disorders and the risk of developing DGBIs. Compared with the causal effect of the risk of developing DGBIs on the risk of developing psychiatric disorders, the risk of developing psychiatric disorders was more likely to causally influence the risk of developing DGBIs. Further sensitivity analyses reinforced the robustness of these results. Our results indicate potential genetic predispositions linking gut microbiota, DGBIs, and psychiatric disorders. This information may be useful for providing new insights into the underlying pathophysiological modulators and treatment strategies for bidirectional dysregulation of brain-gut interactions.

This study was aimed to explore the effect of Zingiberis Rhizoma extract on rats with antibiotic-associated diarrhea(AAD), and reveal the modulation of gut microbiota during alleviation of AAD. AAD rat model was successfully established by exposing rats to appropriate antibiotic mixed solution. Peficon(70 mg·kg~(-1)·d~(-1)) was used as positive control, then rats were treated with 200 mg·kg~(-1)·d~(-1) and 400 mg·kg~(-1)·d~(-1) of Zingiberis Rhizoma extract for low and high dosage groups of Zingiberis Rhizoma extract, respectively. The weight changes of the rats were observed, and the degree of diarrhea were evaluated by fecal score, 120 min fecal weight and fecal water content. Colon tissues for histopathological examination were stained with hematoxylin and eosin(HE), and 16 S rRNA sequencing analysis of gut microbiota was performed. The results showed that compared with the model group, the degree of diarrhea, indicated by fecal water content, fecal score, and 120 min fecal weight of positive control group, Zingiberis Rhizoma low-dose group and Zingiberis Rhizoma high-dose group were significantly ameliorated. And the treatment of Zingiberis Rhizoma could significantly improve the pathological condition of colon tissue in AAD rats, especially the high dose of Zingiberis Rhizoma. In addition, 16 S rRNA sequencing analysis of gut microbiota showed that the diversity and abundance of gut microbiota were significantly improved and the reco-very of gut microbiota was accelerated after given high-dose of Zingiberis Rhizoma, while no significant changes of alterations were observed after given Pefikon. Of note, compared with the pefikon group, the abundance and diversity of gut microbiota in Zingi-beris Rhizoma high-dose group were significantly elevated. At the phylum level, the abundance of Firmicutes in AAD rats increased and the abundance of Proteobacteria was decreased after the Zingiberis Rhizoma intervention. At the genus level, the abundance of Bacillus spp., Lachnoclostridium and Escherichia coli-Shigella were decreased, and the abundance of Lactobacillus spp., Trichophyton spp., and Trichophyton spp., etc., were increased. While compared with the AAD model group, there was no significant difference of gut microbiota after given Peficon. The results showed that Zingiberis Rhizoma exerted beneficial health effects against AAD, and positively affected the microbial environment in the gut of rats with AAD.

Objectives: Correct diagnosis of iron deficiency remains challenging due tothe cost of ferritin tests. Physicians, especially those in resource-limited settings, mayresort to a complete blood count (CBC) when considering iron deficiency and anemia due toits accessibility. Although this has been practiced, it is still beneficial to assesswhether CBC parameters exhibit the diagnostic capability of discriminating such medicalconditions.Materials and Methods: Serum ferritin and CBC were performed on venous bloodsamples of 170 Filipino women aged 18–44 years. The diagnostic ability of the CBCparameters to detect iron deficiency and iron deficiency anemia was analyzed usingreceiver operating characteristic (ROC) curves. Iron deficiency was defined as a ferritinlevel <30 µg/L, while iron deficiency anemia was defined as a ferritin level <30µg/L with hemoglobin level <120 g/L.Results: Ferritin levels correlated with red blood cell (RBC) count andhematocrit levels. With an area under the ROC curve (AUC) of 0.60, a hematocrit cutoffvalue of 38.5% was found to have low discriminating power in diagnosing iron deficiencyonly. Five parameters were observed to have higher discriminating powers for irondeficiency anemia: RBC count cutoff at 4.04 × 1012/L with AUC of 0.73, meancorpuscular volume (MCV) at 84.10 fL with AUC of 0.77, mean corpuscular hemoglobinconcentration (MCHC) at 337.5 g/L with AUC of 0.80, mean corpuscular hemoglobin (MCH) at29.15 pg with AUC of 0.81, and hematocrit at 35.5% with AUC of 0.96.Conclusion: CBC parameters can be a satisfactory discriminator for irondeficiency anemia among the women studied. However, further studies are needed toelucidate its utility in discriminating iron deficiency. With further investigations inthis field, the potential use of CBC as a diagnostic tool for iron deficiency and irondeficiency anemia is promising, particularly in rural areas.

Hemocytometric parameters like red blood cell (RBC) count, mean red blood cell volume (MCV), reticulocyte count, red blood cell distribution width (RDW-SD) and zinc protoporphyrin (ZPP) are frequently established for discrimination between iron-deficiency anemia and thalassemia in subjects with microcytic erythropoiesis. However, no single marker or combination of tests is optimal for discrimination between iron-deficiency anemia and thalassemia. This is the reason why many algorithms have been introduced. However, application of conventional algorithms, only resulted in appropriate classification of 30-40% of subjects. In this mini-review the efficacy of innovative hematological parameters for detection of alterations in RBCs has been considered. It refers to parameters concerning hemoglobinization of RBCs and reticulocytes and the percentages microcytic and hypochromic RBCs, for discrimination between subjects with iron-deficiency anemia (IDA) or thalassemia as well as a combination of both. A new discriminating tool including the above mentioned parameters was developed, based on two precondition steps and discriminating algorithms. The percentage microcytic RBCs is considered in the first precondition step. MCV, RDW-SD and RBC count are applied in the second precondition step. Subsequently, new algorithms, including conventional as well as innovative hematological parameters, were assessed for subgroups with microcytic erythropoiesis. The new algorithms for IDA discrimination yielded results for sensitivity of 79%, specificity of 97%, positive and negative predictive values of 74% and 98% respectively. The algorithms for β-thalassemia discrimination revealed similar results (74%, 98%, 75% and 99% respectively). We advocate that innovative algorithms, including parameters reflecting hemoglobinization of RBCs and reticulocytes, are integrated in an easily accessible software program linked to the hematology equipment to improve the discrimination between IDA and thalassemia.

BackgroundThe relationships between psychosocial stress and diet with gut microbiota composition and diversity deserve ongoing investigation. The primary aim of this study was to examine the associations of psychosocial stress measures and dietary variables with gut microbiota genera abundance and alpha diversity among young adult, black and white females. The secondary aim was to explore mediators of psychosocial stress and gut microbiota diversity and abundance.MethodsData on 60 females who self-identified as African American (AA; n = 29) or European American (EA; n = 31) aged 21–45 years were included. Cortisol was measured in hair and saliva, and 16S analysis of stool samples were conducted. Discrimination experiences (recent and lifetime), perceived stress, and depression were evaluated based on validated instruments. Spearman correlations were performed to evaluate the influence of psychosocial stressors, cortisol measures, and dietary variables on gut microbiota genus abundance and alpha diversity measured by amplicon sequence variant (ASV) count. Mediation analyses assessed the role of select dietary variables and cortisol measures on the associations between psychosocial stress, Alistipes and Blautia abundance, and ASV count.ResultsAA females were found to have significantly lower ASV count and Blautia abundance. Results for the spearman correlations assessing the influence of psychosocial stress and dietary variables on gut microbiota abundance and ASV count were varied. Finally, diet nor cortisol was found to partially or fully mediate the associations between subjective stress measures, ASV count, and Alistipes and Blautia abundance.ConclusionIn this cross-sectional study, AA females had lower alpha diversity and Blautia abundance compared to EA females. Some psychosocial stressors and dietary variables were found to be correlated with ASV count and few gut microbiota genera. Larger scale studies are needed to explore the relationships among psychosocial stress, diet and the gut microbiome.

Objective: To understand the current status of anemia, iron deficiency, and iron-deficiency anemia among preschool children in China. Methods: A cross-sectional study was conducted with a multi-stage stratified sampling method to select 150 streets or townships from 10 Chinese provinces, autonomous regions, or municipalities (East: Jiangsu, Zhejiang, Shandong, and Hainan; Central: Henan; West: Chongqing, Shaanxi, Guizhou, and Xinjiang; Northeast: Liaoning). From May 2022 to April 2023, a total of 21 470 children, including community-based children aged 0.5 to<3.0 years receiving child health care and kindergarten-based children aged 3.0 to<7.0 years, were surveyed. They were divided into 3 age groups: infants (0.5 to<1.0 year), toddlers (1.0 to<3.0 years), and preschoolers (3.0 to<7.0 years). Basic information such as sex and date of birth of the children was collected, and peripheral blood samples were obtained for routine blood tests and serum ferritin measurement. The prevalence rates of anemia, iron deficiency, and iron-deficiency anemia were analyzed, and the prevalence rate differences were compared among different ages, sex, urban and rural areas, and regions using the chi-square test. Results: A total of 21 460 valid responses were collected, including 10 780 boys (50.2%). The number of infants, toddlers, and preschoolers were 2 645 (12.3%), 6 244 (29.1%), and 12 571 (58.6%), respectively. The hemoglobin level was (126.7±14.8) g/L, and the serum ferritin level was 32.3 (18.5, 50.1) μg/L. The overall rates of anemia, iron deficiency, and iron-deficiency anemia were 10.4% (2 230/21 460), 28.3% (6 070/21 460), and 3.9% (845/21 460), respectively. The prevalence rate of anemia was higher for boys than for girls (10.9% (1 173/10 780) vs. 9.9% (1 057/10 680), χ2=5.58, P=0.018), with statistically significant differences in the rates for infants, toddlers and preschoolers (18.0% (475/2 645), 10.6% (662/6 244), and 8.7% (1 093/12 571), respectively, χ2=201.81, P<0.01), and the rate was significantly higher for children in rural than that in urban area (11.8% (1 516/12 883) vs. 8.3% (714/8 577), χ2=65.54, P<0.01), with statistically significant differences in the rates by region (χ2=126.60, P<0.01), with the highest rate of 15.8% (343/2 173) for children in Central region, and the lowest rate of 5.3% (108/2 053) in Northeastern region. The prevalence rates of iron deficiency were 33.8% (895/2 645), 32.2% (2 011/6 244), and 25.2% (3 164/12 571) in infants, toddlers, and preschoolers, respectively, and 30.0% (3 229/10 780) in boys vs. 26.6% (2 841/10 680) in girls, 21.7% (1 913/8 821), 40.0% (870/2 173), 27.1% (2 283/8 413), 48.9% (1 004/2 053) in Eastern, Central, Western, and Northeastern regions, respectively, and each between-group showed a significant statistical difference (χ2=147.71, 29.73, 773.02, all P<0.01). The prevalence rate of iron-deficiency anemia showed a significant statistical difference between urban and rural areas, 2.9% (251/8 577) vs. 4.6% (594/12 883) (χ2=38.62, P<0.01), while the difference in iron deficiency prevalence was not significant (χ2=0.51, P=0.476). Conclusions: There has been a notable improvement in iron deficiency and iron-deficiency anemia among preschool children in China, but the situation remains concerning. Particular attention should be paid to the prevention and control of iron deficiency and iron-deficiency anemia, especially among infants and children in the Central, Western, and Northeastern regions of China.

Background: Iron deficiency anemia (IDA) and β-thalassemia trait (β-TT) are the most common microcytic hypochromic anemias in children. Distinguishing between these conditions is essential for accurate management and genetic counseling, especially in resource-limited settings where advanced diagnostic testing may not be readily available. Red cell indices provide a simple and cost-effective method for differentiating between red blood cells. Objective: To determine and compare mean red cell indices in children aged 6 months to 2 years with iron deficiency anemia and β-thalassemia minor. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Unit-C of Khyber Teaching Hospital, Peshawar, Pakistan. Duration of Study: 21-October-2024 to 21-April-2025. Methods: A total of 60 children aged 6 months to 2 years were enrolled, including 30 with IDA and 30 with β-TT. Children were classified as IDA if hemoglobin was &lt;13 g/dL with serum ferritin &lt;10 ng/mL, and as β-TT if hemoglobin was &lt;13 g/dL with HbA2 &gt;7%. Venous blood samples were analyzed for hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), and red blood cell (RBC) count. Statistical analysis was performed using SPSS (version [insert]), with p &lt; 0.05 considered significant. Results: The mean MCV was significantly higher in IDA (75.04 ± 2.06 fL) compared to β-TT (72.89 ± 1.77 fL; p &lt; 0.0001). MCHC was lower in IDA (31.59 ± 1.49 g/dL) than in β-TT (34.44 ± 1.13 g/dL; p &lt; 0.0001). RDW was markedly elevated in β-TT (19.39 ± 1.71%) compared to IDA (14.32 ± 1.64%; p &lt; 0.0001). RBC counts were higher in β-TT (4.90 ± 0.98 ×10⁶/μL) compared to IDA (4.06 ± 0.62 ×10⁶/μL; p &lt; 0.0001). Conclusion: Red cell indices, including MCV, MCHC, RDW, and RBC count, demonstrated significant differences between IDA and β-TT. These findings support their role as simple, reliable, and cost-effective discriminators in differentiating between the two conditions in pediatric populations.

BackgroundParenteral iron preparations, like ferric carboxymaltose (FCM), are commonly used to manage moderate-to-severe iron deficiency anemia (IDA). Real-world data on efficacy and safety of FCM is limited in India.MethodsA retrospective, observational and real-world study was conducted to assess the efficacy and safety of FCM in adolescents and adults with IDA across 269 centers in India. Data was retrieved from medical records of patients who received FCM for management of IDA. Physicians’ clinical assessment of efficacy and safety of FCM was also assessed. Data were analyzed for hematological parameters at baseline and at 4 ± 1 week for study population, and for severity of anemia.ResultsIn 1800 patients with IDA, intravenous FCM resulted in a significant increase in hemoglobin (Hb) of 2.76 g/dL, serum ferritin of 35.85 µg/L, red blood cell (RBC) count, hematocrit, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) (P < 0.001 for all) at 4 ± 1 week as compared to baseline. In subjects with severe IDA, an increase in Hb was of 3.31 g/dL, serum ferritin increased of 35.84 µg/L, RBC count, hematocrit and MCH improved significantly (P < 0.001 for all). In subjects with moderate IDA, Hb (increase of 2.63 g/dL), serum ferritin (increase of 35.92 µg/L), RBC count, hematocrit, MCV, and MCH improved significantly (P < 0.001 for all). In subjects with mild IDA, only the mean Hb values at 4 weeks were significantly higher (P < 0.001; increased by 1.89 g/dL). Physicians rated efficacy of FCM as very good to good in 97.5% of patients. Similarly, safety of FCM was rated very good to good in 97.2% subjects.ConclusionFCM efficiently, safely and quickly corrects moderate-to-severe anemia in Indian patients in a short span of 4 weeks. Physicians’ positive clinical impression of efficacy and safety supports clinical usage of FCM in real-world scenario.

Objective To investigate the changes in liver and kidney function, red blood cell (RBC) count and hemoglobin (HGB) levels in patients undergoing ultrasound-guided percutaneous microwave ablation (UPMWA) for uterine fibroids on postoperative day 1. Methods The changes in liver and kidney function, RBC count and HGB levels in 181 patients who underwent selective UPMWA in the Second Affiliated Hospital of Shantou University Medical College, China, between August 2017 and January 2023 were retrospectively analyzed. Results All patients underwent UPMWA for uterine fibroids; 179 patients had multiple uterine fibroids and 2 patients had single uterine fibroids. The maximum fibroid diameter ranged from 18 to 140 mm, with an average of 68.3 mm. Ultrasound imaging was used to confirm that the blood flow signal within the mass had disappeared in all patients, indicating that the ablation was effective. Within 24 h, compared with before UPMWA, levels of total bilirubin, direct bilirubin, indirect bilirubin and aspartate aminotransferase had significantly increased (p < 0.01), whereas levels of total protein, albumin, globulin, alanine aminotransferase, creatinine and urea had significantly decreased (p < 0.01). Acute kidney injury (AKI) occurred in 1 of the 181 patients. The RBC count and HGB levels decreased significantly after UPMWA (p < 0.01). Conclusion Ultrasound-guided percutaneous microwave ablation for uterine fibroids can impose a higher detoxification load on the liver and cause thermal damage to and the destruction of RBCs within local circulation, potentially leading to AKI. Protein levels significantly decreased after UPMWA. Therefore, perioperative organ function protection measures and treatment should be actively integrated into clinical practice to improve prognosis and enhance recovery.

Background: Iron deficiency anemia (IDA) and electrolyte imbalance are widely prevalent problems in Indian population. Although few studies have linked IDA with altered serum electrolyte levels, their results were inconsistent. Since IDA is a major public health problem, the suggested relationship between the two assumes clinical importance. In IDA, red cell membrane-bound Na+K+ATase activity is altered affecting the serum electrolyte levels. Aims and Objectives: To evaluate the alterations in serum electrolyte levels in patients with IDA and comparing it with subjects without anemia. Materials and Methods: Totally, 300 subjects (163 with IDA and 137 without anemia) were included. Blood samples analyzed for serum electrolytes, complete hemogram, and iron profile. Results: We observed significantly lower serum levels of sodium, higher potassium, as well as chloride in IDA patients when compared with subjects without anemia (P = 0.0001**). In IDA patients, a significant positive correlation existed between serum sodium levels with all red cell indices except mean corpuscular volume (MCV) and between bicarbonate levels with hemoglobin (Hb), red blood cell (RBC) count, hematocrit (HCT), and MCV. We observed significant negative correlation between serum potassium levels with Hb, RBC count, HCT, and Mean Corpuscular Hemoglobin Concentration (MCHC) and between chloride levels with Hb and HCT. We found a highly significant association in serum sodium and potassium levels as severity of anemia worsen when compared with chloride and bicarbonate levels. Conclusion: Differences in serum electrolyte levels exist between patients with IDA and without anemia. Hence, IDA patients should be monitored closely for their electrolyte levels to avoid complications and better management.

This study aimed to investigate the relationship among smoking, TNF-α-blocker therapy, and the dynamic changes in gut microbiota in patients with ankylosing spondylitis (AS). Using a 16S rRNA sequence, 98 fecal samples of 20 AS patients collected after 0, 1, 3 and 6months of anti-TNF-α treatment and from 20 matched health controls were examined. The variation in composition, abundance, and diversity of gut microbiota was analyzed. The dynamic effects of smoking and treatment on gut microbiota and therapeutic efficacy in AS patients were studied. The increased relative abundance of microbiota in AS nonsmokers was g_Comamonas and g_Desulfovibrio, while that in AS smokers was g_Actinomyces, g_Collinsella, g_Lachnospiraceae_UCG-008, and g_Paraprevotella. The relative abundance of gut microbiota showed dynamic variation. The improvement rate of ASDAS in AS nonsmokers was higher than that in AS smokers (2.297 vs 1.736) after anti-TNF-α treatment. The β-diversity of gut microbiota in AS smokers was lower than that in AS nonsmokers and improved with treatment. Both smoking and TNF-α-blocker had significant effects on the composition, relative abundance, and diversity of gut microbiota in AS patients. The AS smokers characteristically shared g_Collinsella and g_Dorea. The relative abundance of gut microbiota revealed high variability and was in dynamic fluctuation during treatment. The response of gut microbiota to anti-TNF-α treatment was found to be heterogeneous and selective. AS nonsmokers showed a greater improvement rate of ASDAS-CRP with treatment than AS smokers did. The AS smokers showed a lower β-diversity of gut microbiota, and improved after treatment. Key Points • Characterized the dynamic variation in gut microbiota in AS patients classified as smokers and nonsmokers during treatment with anti-TNF-α. • Confirmed the interaction between smoking, anti-TNF-α therapy, and gut microbiota.

Selenium (Se), Manganese (Mn), and Chromium (Cr) are dietary minerals ingested from specific grains, vegetables, and animal meats. Prior research showed that these minerals affect animal erythrocyte health but have unknown effects on human red blood cells (RBCs) and hematology. This study evaluated the effects of these dietary minerals on RBC count, hematocrit, and hemoglobin. We conducted a cross-sectional analysis of 23,844 American participants from the 2015-2016 and 2017-2020 National Health and Nutrition Examination Survey. We evaluated sex, age, ethnicity, education, income, and smoking status as covariates. Linear regression analyses were conducted to evaluate the effect of Cr, Se, and Mn on RBC count, hematocrit, and hemoglobin levels. We employed subpopulation-exclusion regressions further to explore the distinct effects of mineral elevation and deficiency. Additional analyses were performed to examine the relationship between Mn and RBC hemoglobin, RBC distribution width, transferrin receptor concentrations, transferrin saturation, and serum iron levels to support the interpretation of our findings. Optimizable ensemble machine learning models were used to corroborate regression results. Adjusting for covariates, Cr was inversely associated with RBC count (Exp(b) = 0.954), hemoglobin (Exp(b) = 0.868), and hematocrit (Exp(b) = 0.668). Conversely, Se was positively associated with RBC count (Exp(b) = 1.003), hemoglobin (Exp(b) = 1.012), and hematocrit (Exp(b) = 1.032). Mn was positively associated with RBC count (Exp(b) = 1.020) but inversely associated with hemoglobin (Exp(b) = 0.945) and hematocrit (Exp(b) = 0.891). Cr was harmful to RBC health in all subpopulations, whereas Se was protective. Mn appears to contribute to the development of microcytic anemia, but only in subjects with clinically elevated Mn levels. Thus, excessive consumption of foods and supplements rich in Cr and Mn may harm human erythrocyte health and hematology.

The two most frequent microcytic anemias are beta-thalassemic trait (beta-TT) and iron deficiency anemia (IDA). Several discrimination indices have been proposed to distinguish between these two conditions. These indices are derived from several simple red blood cell indices, like red blood cell (RBC) count, mean cell volume, and RBC distribution width (RDW), as these are provided by electronic cell counters. The purpose of the study is to examine the diagnostic accuracy of six discrimination indices in the differentiation between IDA and beta-TT. The six discrimination indices that were examined were as follows: Mentzer Index (MI), Green & King Index (G&K), RDW Index (RDWI), England & Fraser Index (E&F), RDW, and RBC count. We calculated these indices on 373 patients (205 men, 168 women) with beta-TT and 120 patients (50 men, 70 women) with IDA, as well as their sensitivity, specificity, positive and negative prognostic value, efficiency, and Youden's index (YI). G&K shows the highest reliability, followed by E&F, RBC count, MI, and RDWI. On the contrary, RDW completely failed to differentiate between IDA and beta-TT. G&K proved to be the most reliable index as it had the highest sensitivity (75.06%), efficiency (80.12%), and YI (70.86%) for the detection of beta-TT. These six discrimination indices cannot be relied on for a safe differential diagnosis between beta-TT and IDA. They do have high specificity, but their sensitivity for the detection of beta-TT is not satisfactory. Consequently, they cannot be used neither as a screening tool for beta-TT because they could result in a significant number of false negative results.

Background β-Thalassemia trait (BTT) often shows microcytosis, a normal or an increased red blood cell (RBC) count, and an elevated level of HbA 2 , which provide the basis for laboratory screening. BTT is an important differential diagnosis of iron deficiency anemia (IDA). Donors with BTT have hemoglobin values comparable with normal; hence, they are accepted for donation and they usually escape diagnosis. Aim The aim of this work was to differentiate BTT from IDA through blood indices performed in routine complete blood count. Patients and methods A total of 200 samples were obtained from apparently healthy adult Egyptian blood donors randomly. Complete blood count and mean corpuscular volume (MCV) were performed to all individuals. Hemoglobin electrophoresis and/or serum ferritin was performed to samples with MCV less than 78 fl. Results Prevalence of BTT in this study was 6%, whereas IDA represented 4.5% of total 200 samples investigated. The cutoff value of MCV 73 fl was 91.7% sensitive and 100% specific in differentiating BTT from IDA. Red blood cell distribution width at level 14.5% or below can differentiate BTT from IDA with 83.3% sensitivity and 100% specificity. RBCs count at value above 5.47 million/mm 3 can differentiate BTT from IDA with 100% sensitivity and 100% specificity.Conclusion The cutoff values of MCV 73 fl or less, RBC count above 5 × 10 6 /mm 3 , and red blood cell distribution width 14.5% or less were suggested to be associated with a high probability of BTT.

The two most frequent microcytic anemias are beta-thalassemic trait (beta-TT) and iron deficiency anemia (IDA). Several discrimination indices have been proposed to distinguish between these two conditions. These indices are derived from several simple red blood cell indices, like red blood cell (RBC) count, mean cell volume, and RBC distribution width (RDW), as these are provided by electronic cell counters. The purpose of the study is to examine the diagnostic accuracy of six discrimination indices in the differentiation between IDA and beta-TT. The six discrimination indices that were examined were as follows: Mentzer Index (MI), Green & King Index (G&K), RDW Index (RDWI), England & Fraser Index (E&F), RDW, and RBC count. We calculated these indices on 373 patients (205 men, 168 women) with beta-TT and 120 patients (50 men, 70 women) with IDA, as well as their sensitivity, specificity, positive and negative prognostic value, efficiency, and Youden's index (YI). G&K shows the highest reliability, followed by E&F, RBC count, MI, and RDWI. On the contrary, RDW completely failed to differentiate between IDA and beta-TT. G&K proved to be the most reliable index as it had the highest sensitivity (75.06%), efficiency (80.12%), and YI (70.86%) for the detection of beta-TT. These six discrimination indices cannot be relied on for a safe differential diagnosis between beta-TT and IDA. They do have high specificity, but their sensitivity for the detection of beta-TT is not satisfactory. Consequently, they cannot be used neither as a screening tool for beta-TT because they could result in a significant number of false negative results.