A new index to discriminate between iron deficiency anemia and thalassemia trait

BACKGROUND: The most common microcytic and hypochromic anemias are iron deficiency anemia and thalassemia trait. Several indices to discriminate iron deficiency anemia from thalassemia trait have been proposed as simple diagnostic tools. However, some of the best discriminative indices use parameters in the formulas that are only measured in modern counters and are not always available in small laboratories. The development of an index with good diagnostic accuracy based only on parameters derived from the blood cell count obtained using simple counters would be useful in the clinical routine. Thus, the aim of this study was to develop and validate a discriminative index to differentiate iron deficiency anemia from thalassemia trait. METHODS: To develop and to validate the new formula, blood count data from 106 (thalassemia trait: 23 and iron deficiency: 83) and 185 patients (thalassemia trait: 30 and iron deficiency: 155) were used, respectively. Iron deficiency, ß-thalassemia trait and a-thalassemia trait were confirmed by gold standard tests (low serum ferritin for iron deficiency anemia, HbA2 > 3.5% for ß-thalassemia trait and using molecular biology for the a-thalassemia trait). RESULTS: The sensitivity, specificity, efficiency, Youden's Index, area under receiver operating characteristic curve and Kappa coefficient of the new formula, called the Matos & Carvalho Index were 99.3%, 76.7%, 95.7%, 76.0, 0.95 and 0.83, respectively. CONCLUSION: The performance of this index was excellent with the advantage of being solely dependent on the mean corpuscular hemoglobin concentration and red blood cell count obtained from simple automatic counters and thus may be of great value in underdeveloped and developing countries.

Evaluation of Left Ventricular Function using New Index in Echocardiography

BACKGROUND: Systolic and diastolic dysfunction frequently coexist in heart failure. The purpose of this study is to evaluate combined systolic and diastolic function in heart failure using new index presented by Dr. Tei. A new index: [(ICT+IRT)/ET] defined as the sum of isovolemic contraction time(ICT) and isovolemic relaxation time(IRT) divided by ejection time(ET). METHOD: Study patients consisted of 71 subjects. 20 normals, 23 patients in NYHA class II, 22 patients in NYHA class III and 6 patients in NYHA class IV. Left ventricular end-systolic and end-diastolic dimension, FS(fractional shortening) were measured by conventional echocardiography. ICT, IRT, ET, ICT/ET, deceleration time of mitral E wave and E/A of mitral flow were also measured.(ICT+IRT)/ET was easily obtained by subtracting ET from the interval between cessation and onset of the mitral inflow to give the sum of ICT and IRT. Cardiac output was calculated by left ventriculography in 10 normals and 19 patients. RESULTS: The mean value of (ICT+IRT)/ET was significantly different between group IV(0.88 +/-0.03) and group I(0.50+/-0.04) and II(0.50+/-0.03)(p<0.01). also, was significant between group IV and group III(0.63+/-0.04)(p<0.05). FS and deceleration time of mitral E wave were also significant between group III and group IV(p<0.05). Cardiac output calculated by left ventriculography was significantly correlated with(ICT+IRT)/ET(n=29, r=-0.463, p<0.05). CONCLUSION: (ICT+IRT)/ET is a new and simple Doppler index of combined systolic and diastolic left ventricular function in patient with heart failure.