Utility of screening tools to differentiate beta thalassemia trait and iron-deficiency anemia - do they serve a purpose in blood donors?

Amanpreet Sundh; Paramjit Kaur; Anshu Palta; Gagandeep Kaur

doi:10.5045/br.2020.2020219

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Original Article

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Blood Res 2020; 55(3):

Published online September 30, 2020

https://doi.org/10.5045/br.2020.2020219

Utility of screening tools to differentiate beta thalassemia trait and iron-deficiency anemia - do they serve a purpose in blood donors?

Amanpreet Sundh¹, Paramjit Kaur², Anshu Palta³, Gagandeep Kaur²

Author Info. +

Department of Transfusion Medicine, ¹All India Institute of Medical Sciences, New Delhi, ²Government Medical College and Hospital, ³Department of Pathology, Government Medical College and Hospital, Chandigarh, India

Correspondence to : Paramjit Kaur, M.D.
Department of Transfusion Medicine, Government Medical College, Sector 32, Chandigarh 160030, India
E-mail: paramjit.gp71@yahoo.com

Received: August 26, 2020; Revised: September 4, 2020; Accepted: September 15, 2020

This is an Open Access article distributed unAcute myeloid leukemia, New FDA approvalsder the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

Background
The aim of this study was to estimate the prevalence of the beta thalassemia trait (BTT) and differentiate it from iron-deficiency anemia (IDA) among blood donors.
Methods
A total of 1,000 samples from blood donors were subjected to complete hemogram with red blood cell indices. Further, Mentzer index (MI) was calculated for samples with mean corpuscular volume (MCV) below 80 fL and mean corpuscular hemoglobin (MCH) below 27 pg. Samples with Mentzer index ＜12 were subjected to naked-eye single-tube red cell osmotic fragility test (NESTROFT) followed by hemoglobin electrophoresis in positive cases. Serum ferritin was assessed in NESTROFT-negative cases.
Results
The prevalence of BTT among blood donors was 3.7% and that of microcytosis among donors was 8.6%. The prevalence of BTT among microcytic donors was 41.8% while that among those with IDA was 11.6%. A value of MI ＜13 was highly sensitive in the diagnosis of BTT. MI ＞13 was found to have both high specificity and high sensitivity for diagnosing IDA.
Conclusion
A moderately high prevalence of BTT was observed among blood donors. Presently, no screening program is mandatory for screening of BTT among blood donors. Indices like MCV, MCH, and Mentzer Index were thus found to be effective to screen for BTT and IDA among blood donors, and NESTROFT was a cost-effective mass screening method to differentiate BTT and IDA.

Keywords Beta thalassemia trait, Blood donors, Mentzer index, NESTROFT, Iron deficiency anemia

Article

Original Article

Blood Res 2020; 55(3): 169-174

Published online September 30, 2020 https://doi.org/10.5045/br.2020.2020219

Utility of screening tools to differentiate beta thalassemia trait and iron-deficiency anemia - do they serve a purpose in blood donors?

Amanpreet Sundh¹, Paramjit Kaur², Anshu Palta³, Gagandeep Kaur²

Correspondence to:Paramjit Kaur, M.D.
Department of Transfusion Medicine, Government Medical College, Sector 32, Chandigarh 160030, India
E-mail: paramjit.gp71@yahoo.com

Received: August 26, 2020; Revised: September 4, 2020; Accepted: September 15, 2020

Abstract

Keywords: Beta thalassemia trait, Blood donors, Mentzer index, NESTROFT, Iron deficiency anemia

Abstract

Fig 1.

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Figure 1.Flow chart for defining of BTT and IDA and the number of cases in the study. Samples with normal serum ferritin and distinct HbA2 band on electrophoresis were defined as having BTT. Samples with serum ferritin below 15 ng/mL were defined as having IDA [10]. Abbreviations: BTT, beta thalassemia trait; IDA, iron-deficiency anemia; MCH, mean corpuscular hemoglobin; MCV, mean corpuscular volume.

Blood Research 2020; 55: 169-174https://doi.org/10.5045/br.2020.2020219

Table 1 . Prevalence of BTT among blood donors..

	Prevalence of BTT (%)	P
Overall	3.7
Voluntary donors	2.48	˂0.01
Replacement donors	13.04
Accepted donors	1.6	˂0.01
Deferred donors	37.2
Males	3.38	˃0.05
Females	7.23
18–30 yr	4.3	˃0.01
30–40 yr	0.6
Urban background	2.8	˃0.05
Rural background	4.8
Consanguinity	64.2	˂0.01
No consanguinity	2.83

Abbreviation: BTT, beta thalassemia trait..

Table 2 . Prevalence and type of anemia among microcytic blood donors..

Microcytic donors	86	Hb>12.5 g/dL	45 (52.4%)	Normal	30
				BTT	15
		Hb<12.5 g/dL	41 (47.6%)	BTT	21
				IDA	10
				Both	1
				None	9

Abbreviations: BTT, beta thalassemia trait; IDA, iron-deficiency anemia..

Table 3 . Association of different MI values with type of anemia..

	BTT	IDA	Others	Total
MI<12	23	0	0	23
MI 12–14	14	1	4	19
MI>14	0	10	1	11
Total	37	11	5	53

Abbreviations: BTT, beta thalassemia trait; IDA, iron-deficiency anemia; MI, Mentzer index..

Table 4 . Comparison of hematological parameters in donors with BTT and non-BTT..

Parameter	BTT (N=37)	Non-BTT (N=963)	P
Hb (g/dL)	12.3±0.57	13.9±1.07	<0.0001
MCV (fL)	70.4±2.84	87.4±6.13	<0.0001
MCH (pg)	23.7±2.43	29.7±1.65	<0.0001
MCHC (%)	30.2±0.81	32.1±1.48	<0.0001
TLC (×10³/mL)	6.26±1.86	6.12±1.77	0.6376
RBC (×10⁶/mL)	5.89±0.34	4.68±0.47	<0.0001
PCV (%)	38.9±2.02	42.1±3.28	<0.0001
RDWc (%)	14.6±0.66	14.5±0.43	0.1756
Platelets (×10³/mL)	223±54.2	250±67.4	0.163

Abbreviations: BTT, beta thalassemia trait; Hb, hemoglobin; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; MCV, mean corpuscular volume; PCV, packed cell colume; RBC, red blood cell; RDWc, red cell distribution width; TLC, total leucocyte count..

Table 5 . Comparison of hematological parameters in donors with BTT and IDA..

Parameter	BTT (N=37)	IDA (N=11)	P
Hb (g/dL)	12.3±0.57	11.5±0.56	<0.001
MCV (fL)	70.4±2.84	76.4±1.44	<0.0001
MCH (pg)	23.7±2.43	27.4±1.12	<0.0001
MCHC (%)	30.2±0.81	31.2±1.67	0.0085
TLC (×10³/mL)	6.26±1.86	5.90±1.94	0.5794
RBC (10⁶/mL)	5.89±0.34	4.60±0.53	<0.0001
PCV (%)	38.9±2.02	35.1±1.72	<0.0001
RDWc (%)	14.6±0.66	16.1±1.36	<0.0001
Platelets (×10³/mL)	223±54.2	192±19.1	0.07
MI	11.4±0.75	17.0±2.05	<0.0001
S. ferritin (ng/mL)	150±73.8 (N=14)	12.9±1.13	<0.0001

Abbreviations: BTT, beta thalassemia trait; Hb, hemoglobin; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; MCV, mean corpuscular volume; MI, Mentzer index; PCV, packed cell colume; RBC, red blood cell; RDWc, red cell distribution width; S. ferritin, serum ferritin; TLC, total leucocyte count..