EFFECTIVENESS OF DISCRIMINANT FUNCTIONS AS SCREENING TESTS IN PREDICTING Β THALASSEMIA TRAIT AMONG PAEDIATRIC POPULATION WITH MICROCYTIC ANEMIA

Main Article Content

Dr. Vara Prasad Bm
Dr. Vamseedhar Annam
Dr. Vinitra K

Keywords

Discriminant functions, microcytosis, Microcytic anemia, BTT

Abstract

Aim: The objective of the present study was to study the effectiveness of various discriminant functions as screening tests in predicting BTT among paediatric population with Microcytic anemia, who were later confirmed by increased HbA2 levels on Agarose gel electrophoresis at alkaline pH (8.6).


Methods: The present study was conducted in the Hematology section Department of Pathology Central Laboratory RRMCH Hospital Bangalore during the period from January 2015 to May 2017. A total number of 300 paediatric patients were included in the present study.


Results: The commonest age group affected was 0-1 year accounting to 48% followed by age group 2-3 year with 22%. Males showed higher preponderance compared to female with M:F ratio [1.4:1]. The prevalence of BTT was 28.33% in the present study. Out of 300 cases 107(35.6%) cases were positive for either both or any one of the indices. All these cases were subjected to electrophoresis. Among these, 85cases showed increased HbA2 levels.


Conclusion: The present study demonstrates that a set of cost-effective screening test like Discriminant Indices along with routine hemogram data in Microcytic Anemia cases can effectively discriminate between BTT and non-BTT. The confirmation of BTT can be done by Hb electrophoresis on agarose gel and HbA2 quantification by automated densitometer scanner.


 

Abstract 72 | pdf Downloads 35

References

1. Grosso MS, Puzone R, Storino MR, Izzo PP. Molecular Basis of Thalassemia. London: IntechOpen; 2012.
2. Thein SL. Molecular basis of β thalassemia and potential therapeutic targets. Blood Cells, Molecules, and Diseases. 2018 May 1;70:54-65.
3. Halberg L. Iron. In: Garrow JS, James WP, Ralph A, editors. Human Nutrition and Dietetics. 10th ed.. Edinburgh: Churchill‑Livingstone; 2000. p. 177‑92.
4. Rathod DA, Kaur A, Patel V, Patel K, Kabrawala R, Patel V et al. Usefulness of cell counter-based parameters and formulas in detection of beta-thalassemia trait in areas of high prevalence. Am J Clin Pathol. 2007; 128(4): 585-589.
5. PRB. World population data sheet. Population Reference Bureau, Washington DC 2010.
6. Sarnaik SA. Symposium –Thalassemia and related Hemoglobinopathies. Indian J paediatr 2005; 72(4): 319-324.
7. Düzenli Kar Y, Özdemir ZC, Emir B, Bör Ö. Erythrocyte indices as differential diagnostic biomarkers of iron deficiency anemia and thalassemia. Journal of Pediatric Hematology/Oncology. 2020 Apr 30;42(3):208-13.
8. Okan V, Cigiloglu A, Cifci S, Yilmaz M, Pehlivan M. Red cell indices and functions differentiating patients with the β-thalassaemia trait from those with iron deficiency anaemia. Journal of International Medical Research. 2009 Feb;37(1):25-30.
9. Demir A, Yarali N, Fisgin T, Duru F, Kara A. Most reliable indices in differentiation between thalassemia trait and iron deficiency anemia. Pediatrics International. 2002 Dec;44(6):612-6.
10. Plengsuree S, Punyamung M, Yanola J, Nanta S, Jaiping K, Maneewong K, Wongwiwatthananukit S, Pornprasert S. Red cell indices and formulas used in differentiation of β-thalassemia trait from iron deficiency in Thai adults. Hemoglobin. 2015 Jul 4;39(4):235-9.
11. Suresh Babu TV, Manjula Shantaram. An Incidence of Beta Thalassemia in South India. International Journal of Research in Pharmacy and Biosciences. 2016; 3(5):1-6.
12. Shivashankara AR, Jailkhani R, Kini A. Hemoglobinopathies in Dharwad, North Karnataka: a hospital-based study. Journal of Clinical and Diagnostic Research. 2008 Feb 1;2(1):593-9.
13. Manglani M, Lokeshwar MR, Vani VG, Bhatia N, Mhaskar V. 'NESTROFT'--an effective screening test for beta thalassemia trait. Indian pediatrics. 1997 Aug 1;34(8):702-7.
14. Agarwal MB, Mehta BC. Symptomatic beta thalassemia Trait. J Postgrad Med 1982; 28(1): 4-8.
15. Madan N, Meera S, Satendra S, Rusia U, Kusum Kela. Red cells Indices and Discriminant Functions in the Detection of Beta-Thalassemia Trait in a Population with High Prevalence of Iron Deficiency Anemia. Indian J Pathol Microbiol. 1999; 42(1): 55-61.
16. Madan N, Sharma S, Sood SK, Colah R, Bhatia HM. Frequency of β-Thalassemia trait and other hemoglobinopathies in northern and western India. Ind J Hum Gen. 2010; 16(1): 16-25.
17. Mohamed M, Edibany KF, Ninos JJ. Douglas Rhone. Usefulness of certain RBC indices in diagnosing and differentiating thalassemia trait from Iron Deficiency anaemia. Am J Clin Pathol. 1999;111:676-82.
18. Ghosh A, Woo JS, Wan CW, Machenry C, Wong V, Ma HK, Chan V, Chan TK. Evaluation of a prenatal screening procedure for β‐thalassaemia carriers in a chinese populationbased on the mean corpuscular volume (MCV). Prenatal diagnosis. 1985 Jan;5(1):59-65.
19. Pearson HA, O'Brien RT, McIntosh S. Screening for thalassemia trait by electronic measurement of mean corpuscular volume. New England Journal of Medicine. 1973 Feb 15;288(7):351-3.
20. Lafferty JD, Crowther MA, Ali MA, Levine M. The evaluation of various mathematical RBC indices and their efficacy in discriminating between thalassemic and non-thalassemic microcytosis. American journal of clinical pathology. 1996 Aug 1;106(2):201-5.
21. Milunsky A. Genetic Disorders and the Fetus: Diagnosis, Prevention, and Treatment. 4th ed. Baltimore, MD: Johns Hopkins University Press. 1998; 673.
22. Maheshwari U, Padhye A, Samant P. Correlation of Sehgal Index and Rbc Indices for screening of Beta Thalassemia Trait. J Med Sci Clin Res 2017; 5(7): 24531-24532.
23. Qazi RA, Shams R, Hassan H. Screening for beta Thalassemia Trait. JRMC. 2014; 18(1): 158-166.