{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:57:01Z","timestamp":1788317821581,"version":"build-2803163510"},"reference-count":116,"publisher":"Walter de Gruyter GmbH","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,1,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Many discriminant formulas have been reported for distinguishing thalassemia trait from iron deficiency in patients with microcytic anemia. Independent verification of several discriminant formulas is deficient or even lacking. Therefore, we have retrospectively investigated discriminant formulas in a large, well-characterized patient population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The investigational population consisted of 2664 patients with microcytic anemia: 1259 had iron deficiency, 1196 \u2018pure\u2019 thalassemia trait (877 \u03b2- and 319 \u03b1-thalassemia), 150 had thalassemia trait with concomitant iron deficiency or anemia of chronic disease, and 36 had other diseases. We investigated 25 discriminant formulas that only use hematologic parameters available on all analyzers; formulas with more advanced parameters were disregarded. The diagnostic performance was investigated using ROC analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The three best performing formulas were the Jayabose (RDW index), Janel (11T), and Green and King formulas. The differences between them were not statistically significant (p&gt;0.333), but each of them had significantly higher area under the ROC curve than any other formula. The Jayabose and Green and King formulas had the highest sensitivities: 0.917 both. The highest specificity, 0.925, was found for the Janel formula, which is a composite score of 11 other formulas. All investigated formulas performed significantly better in distinguishing \u03b2- than \u03b1-thalassemia from iron deficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In our patient population, the Jayabose RDW index, the Green and King formula and the Janel 11T score are superior to all other formulas examined for distinguishing between thalassemia trait and iron deficiency anemia. We confirmed that all formulas perform much better in \u03b2- than in \u03b1-thalassemia carriers and also that they incorrectly classify approximately 30% of thalassemia carriers with concomitant other anemia as not having thalassemia. The diagnostic performance of even the best formulas is not high enough for making a final thalassemia diagnosis, but in countries with limited resources, they can be helpful in identifying those patients who need further examinations for genetic anemia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2016-0856","type":"journal-article","created":{"date-parts":[[2017,2,9]],"date-time":"2017-02-09T05:02:50Z","timestamp":1486616570000},"source":"Crossref","is-referenced-by-count":36,"title":["Critical appraisal of discriminant formulas for distinguishing thalassemia from iron deficiency in patients with microcytic anemia"],"prefix":"10.1515","volume":"55","author":[{"given":"Elo\u00edsa","family":"Urrechaga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes J.M.L.","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","reference":[{"key":"ref41","first-page":"692","article-title":"A strategy to detect \u03b2 thalassaemia minor","volume":"1","year":"1977","journal-title":"Lancet"},{"key":"ref551","first-page":"55","article-title":"Red cell indices and discriminant functions in the detection of beta-thalassaemia trait in a population with high prevalence of iron deficiency anaemia","volume":"42","year":"1999","journal-title":"Indian J Pathol Microbiol"},{"key":"ref101","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1097\/00043426-199907000-00040","article-title":"Differentiating iron deficiency anemia from thalassemia minor by using an RDW-based index","volume":"21","year":"1999","journal-title":"J Ped Hematol Oncol"},{"key":"ref861","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1532\/LH96.06044","article-title":"Innovative parameters RET-Y sTfR, and sTfR-F index in patients with microcytic, hypochromic anemia\u2013their special value for hemoglobinopathies","volume":"13","year":"2007","journal-title":"Lab Hematol"},{"key":"ref871","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1111\/j.1751-553X.2012.01442.x","article-title":"Reticulocyte hemoglobin equivalent to detect thalassemia and thalassemic hemoglobin variants","volume":"34","year":"2012","journal-title":"Int J Lab Hematol"},{"key":"ref471","doi-asserted-by":"crossref","first-page":"e0114061","DOI":"10.1371\/journal.pone.0114061","article-title":"Discrimination index of microcytic anemia in young soldiers: a single institutional analysis","volume":"10","year":"2015","journal-title":"PLoS One"},{"key":"ref01","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/ajh.24201","article-title":"How we diagnose and treat iron deficiency anemia","volume":"91","year":"2016","journal-title":"Amer J 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differentiating iron deficiency anemia from \u00df-thalassemia trait","volume":"26","year":"2010","journal-title":"Pakist J Med Sci"},{"key":"ref1141","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1159\/000205600","article-title":"Red blood cell distribution width analysis in differentiation between iron deficiency and thalassemia minor","volume":"80","year":"1988","journal-title":"Acta Haematol"},{"key":"ref501","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/ijlh.12290","article-title":"Differential diagnosis of microcytic anemia: the role of microcytic and hypochromic erythrocytes","volume":"37","year":"2015","journal-title":"Int J Lab Hematol"},{"key":"ref1121","first-page":"93","article-title":"Validity assessment of nine discriminant functions used for the differentiation between iron deficiency anemia and thalassemia minor","volume":"53","year":"2007","journal-title":"J Trop Pediatr"},{"key":"ref71","first-page":"481","article-title":"A new red cell 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heterozygous thalassemic syndromes: comparison of its specificity to five other discriminants","volume":"15","year":"1989","journal-title":"Blood Cells"},{"key":"ref161","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1179\/102453311X12940641877849","article-title":"Proposal of a score combining red blood cell indices for early differentiation of beta-thalassemia minor from iron deficiency anemia","volume":"16","year":"2011","journal-title":"Hematology"},{"key":"ref1091","first-page":"1514","article-title":"Differentiation of iron deficiency from thalassaemia trait","volume":"1","year":"1973","journal-title":"Lancet"},{"key":"ref91","first-page":"177","article-title":"Red cell distribution width as a measure of severity of iron deficiency in iron deficiency anemia","volume":"100","year":"1994","journal-title":"Ind J Med Res"},{"key":"ref521","doi-asserted-by":"crossref","first-page":"310","DOI":"10.4103\/0377-4929.162862","article-title":"Sehgal index: a new index and its 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Health"},{"key":"ref141","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1111\/j.1751-553X.2007.00966.x","article-title":"Evaluation of the diagnostic reliability of different RBC indices and formulas in the differentiation of the beta-thalassaemia minor from iron deficiency in Palestinian population","volume":"30","year":"2008","journal-title":"Int J Lab Hematol"},{"key":"ref931","first-page":"533","article-title":"Distinction of microcytic disorders: comparison of expert, numerical-discriminant, and microcomputer analysis","volume":"15","year":"1989","journal-title":"Blood Cells"},{"key":"ref271","first-page":"195","article-title":"Measurement of reticulocyte and red blood cell indices in patients with iron deficiency anemia and beta-thalassemia minor","volume":"43","year":"2005","journal-title":"Clin Chem Lab Med"},{"key":"ref211","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3109\/03630269.2014.930044","article-title":"Red cell indices and formulas used in 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thalassaemia screening","volume":"49","year":"1992","journal-title":"Med Lab Sci"},{"key":"ref1061","first-page":"1752","article-title":"Discriminant value of % microcytic\/% hypochromic ratio in the differential diagnosis of microcytic anemia","volume":"46","year":"2008","journal-title":"Clin Chem Lab Med"},{"key":"ref1081","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/ijlh.12290","article-title":"Differential diagnosis of microcytic anemia: the role of microcytic and hypochromic erythrocytes","volume":"37","year":"2015","journal-title":"Int J Lab Hematol"},{"key":"ref541","first-page":"93","article-title":"Validity assessment of nine discriminant functions used for the differentiation between iron deficiency anemia and thalassemia minor","volume":"53","year":"2007","journal-title":"J Trop Pediatr"},{"key":"ref751","first-page":"368","article-title":"A new valid formula in differentiating iron deficiency anemia from \u00df-thalassemia 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