{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:00:06Z","timestamp":1790172006902,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Since the 1970s, more than 40 red blood cell\u2013based formulas have been proposed to differentiate \u03b2\u2010thalassaemia trait (BTT) from iron deficiency (ID) and iron deficiency anaemia (IDA), the main causes of microcytic anaemia. In Germany, where haemoglobinopathies are rare in the autochthonous population but increasingly encountered due to migration, rapid, low\u2010cost screening tools are of growing importance. This study benchmarked more than 40 published discrimination indices (1973\u20132024) in a large laboratory dataset and explored new formulas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a retrospective analysis, 1316 of 5715 screened records met predefined criteria and were stratified into a BTT group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009953) and an ID\/IDA group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009363). Diagnostic performance was assessed using sensitivity, specificity, Youden's index and ROC analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No established index reliably separated BTT from ID\/IDA, and performance was strongly cut\u2010off\u2010dependent: the best indices reached AUCs of approximately 0.80 with their published cut\u2010offs (e.g., Wongprachum, 0.803) but up to 0.879 on cut\u2010off\u2010independent ROC analysis (Jayabose), indicating that published cut\u2010offs are not directly transferable between populations. In the independent test dataset, three newly derived formulas performed comparably to the best published indices (AUCs 0.916\u20130.923 vs. up to 0.915); rather than outperforming existing models, their advantage lies in offering selectable cut\u2010offs for sensitivity\u2010, specificity\u2010 or balance\u2010oriented use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Local validation of discrimination indices and cut\u2010offs is essential before clinical use. Simple CBC\u2010based formulas may serve as low\u2010cost preselection tools to identify individuals requiring further evaluation. As the new formulas were validated internally only, external validation is required before clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijlh.70252","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:04:47Z","timestamp":1790168687000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differentiating \u03b2\u2010Thalassaemia From Iron Deficiency: Performance and Cut\u2010Off Dependency of More Than 40 Red Cell Discrimination Indices in a Large German Cohort"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4495-1257","authenticated-orcid":false,"given":"Rafid","family":"Al\u2010Nabhan","sequence":"first","affiliation":[{"name":"Department of Paediatric Oncology and Haematology Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin  Berlin Germany"},{"name":"Department of Laboratory Medicine Diamedis Medical Care Centre for Diagnostic Medicine (Ltd.), Part of the Amedes Group  Bielefeld Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3368-0121","authenticated-orcid":false,"given":"Dani","family":"Hakimeh","sequence":"additional","affiliation":[{"name":"Children's Hospital, Medical Faculty Otto\u2010von\u2010Guericke University Magdeburg  Magdeburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6828-1783","authenticated-orcid":false,"given":"Lena","family":"Oevermann","sequence":"additional","affiliation":[{"name":"Department of Paediatric Oncology and Haematology Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Beta\u2010Thalassaemie","author":"Holger Cario F. 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J.","year":"2023","journal-title":"British Journal of Haematology"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1024\/0040\u20105930.63.1.5"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103026(21)00168\u2010X"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52429"},{"issue":"1","key":"e_1_2_13_20_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1177\/0004563216675185","article-title":"Ferritin and Iron Studies in Anaemia and Chronic Disease","volume":"54","author":"Peng Y. Y.","year":"2017","journal-title":"Annals of Clinical Biochemistry"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.15761\/JPR.1000125"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7459.209"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7458.168"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gene.2023.148022"},{"key":"e_1_2_13_25_1","unstructured":"R.Al\u2010Nabhan \u201cEvaluation of Hemoglobinopathy Screening Indices for the Identification of Thalassemia Carriers: Comparison of Blood Count Parameters and Hemoglobin Electrophoresis \u201ddoctoral thesis submitted to Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin 2026."}],"container-title":["International Journal of Laboratory Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijlh.70252","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ijlh.70252","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijlh.70252","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:04:52Z","timestamp":1790168692000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijlh.70252"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":24,"alternative-id":["10.1111\/ijlh.70252"],"URL":"https:\/\/doi.org\/10.1111\/ijlh.70252","archive":["Portico"],"relation":{},"ISSN":["1751-5521","1751-553X"],"issn-type":[{"value":"1751-5521","type":"print"},{"value":"1751-553X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]},"assertion":[{"value":"2026-06-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ijlh.70252"}}