Evaluation of Indices in Differentiation Between Iron Deficiency Anemia and β-Thalassemia Trait for Chinese Children

Iron deficiency anemia (IDA) and beta-thalassemia trait (beta-TT) are the most common microcytic anemia. Kinds of discrimination indices have been established as simple, fast, and inexpensive means since 1970s. This study evaluates the validity of 12 indices in differentiation between IDA and beta-TT for Chinese children. The 12 discrimination indices were red blood cell (RBC) count, RBC distribution width, Mentzer Index, Green and King Index, RBC distribution width Index, England and Fraser Index, Shine and Lal Index, Srivastava Index, Ricerca Index, Ehsani Index, Sirdah Index, and Huber-Herklotz-Index. A total of 300 children (beta-TT, n=127 and IDA, n=173) were enrolled in the study. We calculated the sensitivity and specificity, positive and negative predictive values, and Youden's index for each index. We also established new cut-off values by receiver operating characteristic curves. Green and King Index showed the highest reliability, as it had the largest area under the curve (AUC=0.947), whereas Srivastava Index and Shine and Lal Index showed the lowest reliability (AUC=0.679 and 0.532, respectively). We concluded Green and King Index, Ricerca Index, and England and Fraser Index could be used in discrimination between IDA and beta-TT in Chinese children.