Validation of new indices for differentiation between iron deficiency anemia and beta thalessemia trait, a study in pregnant females


  • Sheetal Arora Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India
  • Deepshikha Rana Department of Pathology, ESIC Medical College, Faridabad, Haryana, India
  • Sachin Kolte Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India
  • Leelawathi Dawson Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India
  • Indrani Dhawan Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India



Red blood cell indices, Microcytic hypochromic anaemias, Lower socio-economic class


Background: The two most frequent types of microcytic hypochromic anemia in developing countries are beta thalassemia trait (????-TT) and iron deficiency anemia (IDA). Several indices using blood cell count parameters have been suggested to differentiate between two. In this study we evaluated the reliability of three indices.

Methods: The present cross-sectional study was carried out in 300 pregnant females in third trimester. Out of these, 90 microcytic hypochromic females were selected. Mentzers index, red cell distribution width index and Matos and Carvalho index (MCI) were calculated from the regular 3-part analyser haematological parameters.  

Results: The Mentzer index was the most reliable index, as it had the highest sensitivity (97.62%), specificity (66.67%), and Youden’s index (64%) for detecting Iron deficiency anaemia; the Matos and Carvalho Index showed higher sensitivity (98.81%)but a much lower specificity (33.3%) and Youden’s index (32%) while the red cell distribution width index showed the sensitivity and specificity of 92.86% and 66.67%, respectively with Youden’s index of 59%.

Conclusions: The Mentzer index provided the highest reliabilities for differentiating IDA from ????-TT. The new indices have high sensitivities and positive predictive value for identifying IDA, making them useful for screening population at risk. 


Metrics Loading ...

Author Biography

Sheetal Arora, Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India

Assistant Professor

Department Of Pathology


Kassebaum N.J, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010 Blood. 2014;5:615-24.

Rodak B.F, Fritsma G.A, Keohane E.M. Hematology: clinical principles and applications, Elsevier Saunders. 2011;4:135-6.

Martin A, Thompson AA. Thalassemias Pediatr Clin North Am. 2013;6:1383-91.

Cao A, Galanello R. Beta-thalassemia Genet Med. 2010;2:61-76.

Lippincot. Blood: principles and practice of hematology. In: Handin R.J, Lux SE, Stossel TP, eds. Blood: principles and practice of hematology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2003.

Mentzer Jr WC. Differentiation of iron deficiency from thalassaemia trait. Lancet. 1973;7808:82.

Srivastava PC. Differentiation of thalassaemia minor from iron deficiency. Lancet. 1973;7821:154-5.

Shine I, Lal S. A strategy to detect beta-thalassaemia minor. Lancet. 1977;8013:692-4.

Ricerca BM, Storti S, d’Onofrio G, Mancini S, Vittori M, Campisi S, et al. Differentiation of iron deficiency from thalassaemia trait: a new approach Haematologica. 1987;5:409-13.

Green R, King R. A new red cell discriminant incorporating volume dispersion for differentiating iron deficiency anemia from thalassemia minor Blood Cells. 1989;3:481-91

Urrechaga E, Borque L, and Escanero J.F. “The role of automated measurement of RBC subpopulations in differential diagnosis of microcytic anemia and ????-thalassemia screening,” American Journal of Clinical Pathology. 2011;135:74–379.

Thomas C and Thomas L. Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Clin Chem. 2002;48:1066-76.

Vehapoglu A, Ozgurhan G, Demir AD, Uzuner S, Nursoy MA, Turkmen S, et al. Hematological indices for differential diagnosis of beta thalassemia trait and iron deficiency anemia. Anemia. 2014;10(5):1-7.

Bordbar E, Taghipour M, Zucconi BE. Reliability of different RBC indices and formulas in discriminating between β-Thalassemia minor and other microcytic hypochromic cases. Mediterr J Hematol Infect Dis. 2015;7(1):1-12.

Huang TC, Wu YY, Chen YG, Lai SW, Wu SC, Ye RH, et al. Discrimination Index of Microcytic Anemia in Young Soldiers: A Single Institutional Analysis. PloS One. 2015;10(2):1-10.

Ismail M, Patel NG. Evaluation of the Diagnostic Accuracy of Twelve Discrimination Indices for differentiating β-thalassemia Trait from Iron Deficiency Anemia. Indian J Public Health Res Dev. 2016;7(1):104-109.

Verma S, Gupta R, Kudesia M, Mathur A, Krishan G, Singh S. Coexisting iron deficiency anemia and Beta thalassemia trait: effect of iron therapy on red cell parameters and hemoglobin subtypes. ISRN Hematol. 2014;12(3):1-4.

Hoffmann JJ, Urrechaga E, Aguirre U. Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia: a meta-analysis. CCLM. 2015;53(12):1883-94

Plengsuree S, Punyamung M, Yanola J, Nanta S, Jaiping K, Maneewong K, et al. Red cell indices and formulas used in differentiation of β-thalassemia trait from iron deficiency in Thai adults. Hemoglobin. 2015;39(4):235-9.

Ehsani M.A, Shahgholi E, Rahiminejad M.S, Seighali F, and Rashidi A. A new index for discrimination between iron deficiency anemia and beta-thalassemia minor: results in 284 patients. Pakistan J Biological Sci. 2009;12(5):473–5.

Brancaleoni V, Di Pierro E, Motta I, Cappellini MD. Laboratory diagnosis of thalassemia. Int J Lab Hematol. 2016;38(S1):32–40.

Rahim F and Keikhaei B. Better differential diagnosis of iron deficiency anemia from beta-thalassemia trait. Turkish J Hematol. 2009;26(3):138–45.






Original Research Articles