Differential diagnosis of thalassemia and iron deficiency anemia in pregnant women using new formulas from multidimensional analysis of red blood cells.

Background Iron deficiency anemia (IDA) and thalassemia trait (TT) are the most common conditions of microcytic hypochromic anemia (MHA) in pregnant women. We used the BC-6800Plus analyzer to study the utility of erythrocyte and reticulocyte parameters for distinguishing TT from IDA in pregnant women. Methods A total of 454 anemic pregnant women, including 340 with IDA, 66 with β-thalassemia trait (β-TT) and 48 with α-thalassemia trait (α-TT), were included. Multiple comparisons among groups were performed, and diagnostic performance of parameters was determined using receiver operating characteristic (ROC) curve analysis, with P<0.05 indicating statistical significance. Results Reticulocyte production index (RPI) and the average volume of mature red blood cells (MCVm) in the IDA group were significantly higher than in the β-TT and α-TT groups. Red blood cell (RBC), reticulocyte percentage (Ret%), and RPI in the IDA group were significantly lower than in the α-TT and β-TT groups. We devised MHA 1=0.42× MCH -0.57× RPI -0.08× %MICROr -9.38 to distinguish IDA from α-TT. With a cut-off value of 0.61, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were 0.868, 90.9%, and 68.5%, respectively. We devised MHA 2=0.04× %MICROr +0.12× MCVm -13.76× Ret# -6.29 to distinguish IDA from β-TT. With a cut-off value of 0.55, the AUC, sensitivity, and specificity were 0.878, 81.3%, and 80.3%, respectively. Conclusions Erythrocyte indices and formulas can be used as initial methods for the differential diagnosis of TT and IDA. MHA 1 and MHA 2 were the most useful indices in the differential diagnosis of α-TT from IDA and β-TT from IDA in pregnant women.