{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:58:17Z","timestamp":1771333097041,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T00:00:00Z","timestamp":1664236800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The Thomas\u2010plot has proven to be a helpful tool to discriminate between different types of anemia. This plot combines the reticulocyte hemoglobin content (Ret\u2010He) with the soluble transferrin receptor (sTfR)\/log ferritin (fer) ratio. In this study, we designed an alternative Thomas\u2010plot in which Ret\u2010He is combined with the transferrin (Tf)\/log ferritin ratio. We validated both Thomas\u2010plots in a population of anemic patients and compared the performance to the current laboratory diagnostics of anemia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 536 anemic patients were included. The first 188 patients were used to generate ROC curves to define the optimal cut\u2010off values for both Thomas\u2010plots. With the following 348 patients included we studied the performance of the alternative and classical Thomas\u2010plots compared to current anemia diagnostics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Cut\u2010off values were defined (Ret\u2010He: 31.2\u00a0pg, sTfR\/log(fer): 0.91, and Tf\/log(fer): 1.71). With both Thomas\u2010plots the amount of <jats:italic>e causa ignota<\/jats:italic> (ECI) cases dropped from 39% to 27%. A more in depth analysis on the iron status of anemia of chronic disease (ACD) patients and a subdivision between latent and classical iron deficiencies could be made with the help of both plots. A shift from classical iron deficiency anemia (IDA) cases according to the classical Thomas\u2010plot toward functional IDA according to the alternative Thomas\u2010plot was observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The alternative Thomas\u2010plot is an effective tool that gives a more in depth view on the iron status of anemic patients. In addition, it is easier to implement due to the use of transferrin rather than the soluble transferrin receptor.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijlh.13964","type":"journal-article","created":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T05:59:00Z","timestamp":1664344740000},"page":"96-103","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The alternative Thomas\u2010plot: A new tool for effective anemia diagnostics"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4550-9033","authenticated-orcid":false,"given":"Kitty","family":"de Leur","sequence":"first","affiliation":[{"name":"Klinisch Chemisch Laboratorium en Trombosedienst Franciscus Gasthuis &amp; Vlietland  Schiedam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadine M. C.","family":"Pouw","sequence":"additional","affiliation":[{"name":"Klinisch Chemisch Laboratorium en Trombosedienst Franciscus Gasthuis &amp; Vlietland  Schiedam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordy","family":"Lopez","sequence":"additional","affiliation":[{"name":"Klinisch Chemisch Laboratorium en Trombosedienst Franciscus Gasthuis &amp; Vlietland  Schiedam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lenneke","family":"Waals\u2010Prinzen","sequence":"additional","affiliation":[{"name":"Klinisch Chemisch Laboratorium en Trombosedienst Franciscus Gasthuis &amp; Vlietland  Schiedam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huib","family":"Ceelie","sequence":"additional","affiliation":[{"name":"Klinisch Chemisch Laboratorium en Trombosedienst Franciscus Gasthuis &amp; Vlietland  Schiedam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen M.","family":"van der Zwan\u2010van Beek","sequence":"additional","affiliation":[{"name":"Klinisch Chemisch Laboratorium en Trombosedienst Franciscus Gasthuis &amp; 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