{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:32:37Z","timestamp":1787070757687,"version":"build-2736575974"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The red blood cell (RBC) indices of dimorphic anemia (DA) may present as macrocytic, microcytic, or normocytic, leading to missed diagnoses when relying solely on empirical judgment of these indices. This is particularly problematic in underdeveloped regions where tests for iron, vitamin B12, and folate status are unavailable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively analyzed patients diagnosed with iron deficiency anemia (IDA) and megaloblastic anemia (MA) at our institution. We compared patient characteristics and complete blood count (CBC) parameters between IDA, MA, and DA, and subsequently developed a diagnostic model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      About 142 DA, 288 IDA, and 60 MA patients were included. DA showed predominant microcytosis, with minor normocytic and rare macrocytic cases, enabling clear differentiation from MA by mean corpuscular volume (MCV) but not IDA. To distinguish DA from IDA, we analyzed patient characteristics and CBC parameters. By univariate analysis and logistic regression, sex, RBC, and WBC were identified as independent predictors. A predictive model assigned scores: 3.5 points for male sex, 1 point for RBC &lt;3.36 \u00d7 10\u00b9\u00b2\/L, and 2 points for WBC &gt; 5.87 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/was built and internally validated. A flowchart for the diagnosis of nutritional anemia was proposed, with a focus on the rational measurement of iron, folate, and vitamin B12 to discover DA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Our algorithm provides a clinical model for DA prediction using simple parameters, enabling targeted guidance for the measurement of iron, vitamin B12, and folate. Noting the single-center limitation and sample constraints, this diagnostic approach requires validation in diverse populations and regions to potentially derive corresponding new models.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jfmpc.jfmpc_308_26","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T14:00:23Z","timestamp":1781791223000},"page":"2082-2087","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["A diagnostic approach incorporating a predictive model based on simple parameters for differentiating dimorphic anemia from nutritional macrocytic or microcytic anemia"],"prefix":"10.4103","volume":"15","author":[{"given":"Ailing","family":"Luan","sequence":"first","affiliation":[{"name":"Zhenjiang Senior High School, Cocodala, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Fourth Division Hospital of Xinjiang Production and Construction Corps, Yining, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengxin","family":"Luan","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Fourth Division Hospital of Xinjiang Production and Construction Corps, Yining, China"},{"name":"Innovation Research Center for High-Incidence Tumors and Metabolic Diseases of the Fourth Division, Yining, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongguo","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"R1-20260619","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1053\/j.seminhematol.2008.07.009","article-title":"Nutritional anemias and the elderly","volume":"45","author":"Carmel","year":"2008","journal-title":"Semin Hematol"},{"key":"R2-20260619","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/j.1751-553X.2007.00911.x","article-title":"Diagnostic clues to megaloblastic anaemia without macrocytosis","volume":"29","author":"Chan","year":"2007","journal-title":"Int J Lab Hematol"},{"key":"R3-20260619","doi-asserted-by":"crossref","first-page":"66","DOI":"10.5005\/jp-journals-10065-0033","article-title":"Prevention of dimorphic anemia through a case study","volume":"2","author":"Malhotra","year":"2018","journal-title":"World J 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Transfusion","volume":"42","author":"Sasidharan","year":"2026","journal-title":"Indian J Hematol Blood Transfus"},{"key":"R8-20260619","first-page":"61","article-title":"Study of dimorphic anemia in adults with reference to basic etiology","volume":"5","author":"Deepthi","year":"2018","journal-title":"Indian J Pathol Oncol"},{"key":"R9-20260619","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s00277-012-1634-8","article-title":"Combined cobalamin and iron deficiency anemia: A diagnostic approach using a model based on age and homocysteine assessment","volume":"92","author":"Remacha","year":"2013","journal-title":"Ann Hematol"},{"key":"R10-20260619","doi-asserted-by":"crossref","first-page":"743","DOI":"10.4102\/ajlm.v8i1.743","article-title":"Morphological patterns of anaemia among pregnant women from Sudan","volume":"8","author":"Abusharib","year":"2019","journal-title":"Afr J Lab Med"},{"key":"R11-20260619","first-page":"1","article-title":"Clinico-hematologic and biochemical profile of dimorphic anemia with bone marrow study","volume":"6","author":"Athar","year":"2014","journal-title":"Internet J Lab Med"},{"key":"R12-20260619","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1001\/archfami.5.10.585","article-title":"Anemia secondary to combined deficiencies of iron and cobalamin","volume":"5","author":"Hash","year":"1996","journal-title":"Arch Fam Med"}],"container-title":["Journal of Family Medicine and Primary 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