Maybe the others can help. This difference in RDW is helpful when you’re trying to differentiate IDA and thalassemia; if you have a microcytic, hypochromic anemia, the next thing you’d do is look at the RDW (or just look at the blood smear). Conclusion: None of the indices was completely sensitive and specific in differentiation between β-TT and IDA. RBC Distribution Width (RDW) o Coefficient of variation in size distribution of RBCs o Displayed as a percentage o Normal value: 1 3 ± 1 .5%. A total of 290 carefully selected children aged 1.1–16 years were evaluated. If the RDW is low (the cells are mostly the same size), then it’s probably thalassemia. Yes – good point! The two most frequent types of microcytic anemia are beta thalassemia trait (β-TT) and iron deficiency anemia (IDA). Pediatric Hematology/Oncology Professor Emeritus, UCSF • helps differentiate whether microcytic anemia is caused fromiron deficiencyor from thalassemia Professor Emeritus, UCSF . Andy created an interesting topic with more values: Iron Deficiency vs. Thalassemia Minor & Hemoglobin Parameters of Thal Groups I personally couldn't say for sure which type of anemia your blood test would indicate. iron-deficiency anemia or None of these different formulations are superior to RBC value obtained from automated analyzers in adult cases with IDA and beta-TT. 1.Hb in TT is not less than 10g/dl but in IDA it is less upto 3g/dl. Notify me of follow-up comments by email. Another thing to do is look at the RBC. how can we differentiate target cell is due to liver disease or thalassemia? Thank you again. We retrospectively evaluated the reliability of various indices for differential diagnosis of microcytosis and β-TT in the same patient groups. Anemia is defined as a hemoglobin level of less than the 5th percentile for age. [7], Measure of red blood cell volume variation as part of a standard blood test. Mathematically, the RDW-CV is calculated with the following formula: Anemia in the presence of a normal RDW may suggest thalassemia. Patient groups have been evaluated according to RBC, RDW, Mentzer index, Shine and Lal index, England and Fraser index, Srivastava index, Green and King index, RDWI and Ricerca index. Could you please explain this and list other ways to tell them apart? You may need to do look at the patient’s other labs (liver function tests, etc) and/or do hemoglobin electrophoresis to figure things out. 1700 South Broadway, New Ulm, MN 56073. Can anyone count how many nuclear lobes that neutrophil has? The red cell distribution width (RDW) is high in iron deficiency anemia because there is a wide variation in red cell size. not forgetting the mentzer index as well — ratio of MCV and RBC – if more than 13 then its likely IDA. [1] If anemia is observed, RDW test results are often used together with mean corpuscular volume (MCV) results to determine the possible causes of the anemia. The Mentzer index which is defined as mean corpuscular volume per red cell count. Legal stuff: Except as noted, the views expressed here are not the views of Regents of the University of Minnesota or any of its regents, faculty, staff or students. Mentzer index. Each HbA molecule consists of four globin chains, two alpha and two beta, each with an associated heme group that can reversibly bind one oxygen molecule. Mentzer index and RDW is a test that is widely used by clinicians to differentiating early screening of Thalassemia with iron deficiency anemia. High RDW may be a result of the presence of fragments, groups of agglutination, and/or abnormal shape of red blood cells. As you suggest in your comment, this test is not a definitive test (it’s pretty specific but not all that sensitive). We also discovered significantly lower MCV, mean Hb (for men and women), Mentzer index, G&K index, iron (for men and women), and folic acid levels as well as significantly higher mean RBC count and RDW in GPCA−/microcytosis patients than in healthy controls (all p values < 0.001 except for mean iron level of men, p = 0.023; Table 1). 1. thank you for the very informative haematology topic…as a Biomedical Scientist…with this additional reinforcement of info as knowledge application it will help me more validate correct clinical lab results for final analysis and lab diagnosis therefore exact prescription and patient`s medication…::: To differentiate anemia and Thalassemia- So there. Causes vary by age. In the case of both iron and B12 deficiencies, there will normally be a mix of both large cells and small cells, causing the RDW to be elevated. Mild thalassemia is microcytic, with a normal or elevated RBC and very mild anisocytosis. I rally Like the information and I understand it very well. Started in 1995, this collection now contains 6897 interlinked topic pages divided into a tree of 31 specialty books and 737 chapters. Higher RDW values indicate greater variation in size. In IDA, the RBC is low (there isn’t enough iron around, so the bone marrow makes fewer cells). Practical Diagnosis of Hematologic Disorders. Probably thalassemia, given the low MCV and normal hemoglobin – but you’d need to do iron studies to be sure , Thank you very much for your help….it makes things at the lab, thanks every one very informative discussion. Background. From a lab perspective you wouldn't just rely on morphology to separate these. This is an unprecedented time. [2], An elevation in the RDW is not characteristic of all anemias. Thus, it is a reasonably accurate term.[4][5]. The Mentzer index, described in 1973 by William C. Mentzer, is the MCV divided by the RBC count. Designed by Elegant Themes | Powered by WordPress. This site uses Akismet to reduce spam. Anemia of chronic diseases show normal RDW. Medical Lab equation. Certain disorders, however, cause a significant variation in cell size. So Iron Deficiency Anemia (IDA) and Thal are the two big microcytic/hypochromic options that you first learn in hematology. Usefulness of red blood cell flags in diagnosing and differentiating thalassemia trait from iron-deficiency anemia J. Eivazi-Ziaei 1, S. Dastgiri 1, S. Pourebrahim 2 and R. Soltanpour 2 1Tabriz University Hematology and Oncology Research Center, Shahid Ghazi Ward, Imam Hospital, Iran, 2 Danesh Clinical Laboratory, Tabriz University of Medical Sciences, Tabriz, Iran 2. Similarly, Srivastava index was calculated by dividing MCH by the RBC count. The reasons for this are unclear. More often, though, there are complications in patients with liver disease: bleeding (leading to iron deficiency and a microcytic anemia) or nutritional abnormalities like folate deficiency (leading to a megaloblastic anemia). You get mark anisopoikilocytosis in anemia and Start studying Tratto talassemico VS carenza di ferro. A low Mentzer Index, calculated from CBC data [MCV/RBC < 13], may suggest this disorder but a hemoglobin electrophoresis would be diagnostic. Methods. So: there are a lot of different features to be aware of. The Absolute Reticulocyte Count & Reticulocyte Index Assesses appropriate response to anemia, frequently in Sickle Cell Disease patients. Several formulas, based on parameters from the CBC, may be used to calculate a thalassemic index and have been used to differentiate iron … I really like... I’ve got a lot of homework to do and your site is one... Now that’s what I call proper mental assortment. 2.RBC is more than 5million but in IDA it is less. thalassemia? This page was last edited on 29 December 2020, at 06:57. It is said to be helpful in differentiating iron deficiency anemia from beta thalassemia.. In the Palestinian population, the Sirdah formula, who had both b-thal trait and iron deficiency, and the children Green & King formula and RDW Index, provided the highest who were carriers of a-thal-1, which affects the red cell reliability in discrimination of b-thal trait from iron defi- … What is thalassemia? You would rely on the patient symptoms, and history as well as other labs such as iron testing. Screening is recommended only for high-risk children. I got a simple calculation based just on CBC (Complete Blood Count) Iron-deficiency anemia usually presents with high RDW and low MCV. Abstract Background: In Tunisia, thalassemia and sickle cell disease (SS) represent the most prevalent monogenic hemoglobin disorders with 2.21% and 1.89% of carriers, respectively. can you help me? In mild thalassemia, however, the RBC tends to be normal or even elevated. if less than 13 its suggestive of thal. yGenetic blood disorder resulting in a mutation or d l ti f th th t t l l bi deletion of the genes that control globin production. Q. I am having trouble differentiating between mild thalassemia and iron-deficiency anemia. Most children with anemia are asymptomatic, and the condition is detected on screening laboratory evaluation. 3.RDW is less than 17% in TT but in IDA it is more than 17%. It is mainly used to differentiate an anemia of mixed causes from an anemia of a single cause. Nice blog, you bring up some very good points. The mean particle size corresponds to the MCV, the distribution width to the RDW, and the average refractive index to the MCHC, as discussed in Friebel and Meinke 48. Learn vocabulary, terms, and more with flashcards, games, and other study tools. An elevated RDW (red blood cells of unequal sizes) is known as anisocytosis. … So the RDW is low. Required fields are marked *. 5th edition. Used for differentiation between iron deficiency anemia and Mediterranean anemia. This was also taken as one of the index for differentiation of thalassemia minor from iron deficiency when it was less than 3.8. please.. In uncomplicated liver disease (in which there is no iron-deficiency anemia due to bleeding, and no folate deficiency), the anemia is macrocytic, and there may be acanthocytes. The Mentzer index (MCV/RBC count) would be around 15.5 in this case. The anemia may even be a mixture of all of these features! Kristine Krafts, M.D. However, a varied size distribution of red blood cells is a hallmark of iron deficiency anemia, and as such shows an increased RDW in virtually all cases. So there are some kind of small cells, and some really small cells (as you can see in the image of iron-deficiency anemia above). Learn how your comment data is processed. (HbA2 and HbF combine alpha globins with delta globins … measure of the range of variation of red blood cell volume that is reported as part of a standard complete blood count. yNormal hemoggplobin is composed of 2 alpha and 2 beta globins yMutations in a given globin gene can cause a decrease in production of that globin resulting in decrease in production of that globin, resulting in [citation needed], High RDW may be a result of the presence of fragments, groups of agglutination, and/or abnormal shape of red blood cells. Overall, the indices performed better for adults than for children. Mentzer index less than 13 was consider as one of the marker for thalassemia. Pomeranian Medical University > Red blood cell indices (indexes), Cornell University, Department of Population Medicine & Diagnostic Sciences > Red Cell Distribution Width (RDW), Encyclopedia of Surgery: A Guide for Patients and Caregivers Red blood cell indices, "Red Cell Distribution Width (RDW): Reference Range, Interpretation, Collection and Panels", RDW Blood Test - Red Blood Cell Distribution Width, Mean corpuscular hemoglobin concentration, https://en.wikipedia.org/w/index.php?title=Red_blood_cell_distribution_width&oldid=996934907, Articles with dead external links from April 2018, Articles with permanently dead external links, Short description is different from Wikidata, Articles with unsourced statements from July 2020, Creative Commons Attribution-ShareAlike License. reason for the RBC count to be normal or elevated is because defect lies at globin chain formation level but no nutritional deficiency otherwise .so process of formation of red cells remains normal or slightly elevated to compensate for early disposal of RBCs.and ps definately helps to differentiate between the two and indices also. The RDW will be elevated in more than 90 percent of persons with iron deficiency, ... Mentzer index for children (MCV/red blood cell count) > 13 < 13 < 13. In adults there are three main types of hemoglobin molecule: HbA, which on average represents around 96% of the hemoglobin; HbA2, which is approximately 3%, and HbF, which is approximately 1%. Red cell Distribution Width Index (RDWI) = MCV × RDW/RBC 2. Mentzer index formula = MCV/ RBCs count; What do Mentzer results mean? You are extremely helpful with your posts. Anemia is classified as microcytic, normocytic, or macrocytic, based on the mean corpuscular volume. As iron-deficiency anemia progresses, and the patient’s serum iron drops lower and lower, each successive wave of new red cells gets smaller and smaller. A. None of the subjects had a combined case of IDA and β-TT. Severe thalassemia is also microytic, but the RBC is low and there is a ton of anisocytosis. How do you differentiate between between beta thalassemia alpha and beta using heamahlobin electrophoresis and full red cell counts. 1. Deficiencies of Vitamin B12 or folate produce a macrocytic anemia (large cell anemia) in which the RDW is elevated in roughly two-thirds of all cases. I am not sure why the red cell distribution width would be lower in thalassemia than IDA. It is the dedication of healthcare workers that will lead us through this crisis. RBC=5.15 HB=13.7 Hct=40.8 MCV=79.3 MCH=26.6. RDW in thalassemias is usually within or very close to the reference interval, reflecting the uniformity of red cell size (microcytes). We calculated 12 discrimination indices in all patients with hemoglobin (Hb) values of 8.7–11.4 g/dL. But you can get a pretty good idea by looking at the things discussed above. An assessment of the performance of the SI according to the β -thalassemia mutation type showed higher YI (87 vs. 82) with moderate mutations that are not necessarily responsible for a greater alteration of hematologic parameters.The lowest index in our study was HH with 77% of Sp and 28% of Se resulting in a very low value of YI (5). Anemia of chronic disease, hereditary spherocytosis, acute blood loss, aplastic anemia (anemia resulting from an inability of the bone marrow to produce red blood cells), and certain hereditary hemoglobinopathies (including some cases of thalassemia minor) may all present with a normal RDW. In mild thalassemia (alpha or beta), the red cells are strangely all the same size; there is virtually no variation. If the RDW is high (the cells vary a lot in size), then it’s probably iron deficiency anemia. To definitively diagnose IDA, you need to do iron studies; to definitively diagnose thalassemia, you need to do hemoglobin electrophoresis. Srivastava index (SI) = MCH/RBC A value less than 220, 13, 3.8 is suggestive of BTT for RDWI, MI, SI respectively Ethical Consideration: The proposal for the study was reviewed and approved by the joint University of Ibadan and University College Home; About; Merchandise; Deals; Donate; Contact Us Keywords: anemia, mentzer index, RDW index, thalesemia. RDW index mean between iron and placebo group after three months observation were 239,96(39,25) vs 235,17(31,77) (p=0,72). Anemia of chronic diseases show normal RDW. “Mentzer Index” William Mentzer, M.D. Recent hemorrhages typically present with high RDW and normal MCV. The lowest performance (DOR=6.8) was found for the RDW (Bessman index). Your email address will not be published. Mentzer Index (MI) = MCV/RBC 3. You’d have to look at the whole smear, the CBC (specifically, the MCV, RBC and RDW), and the patient’s clinical status. To separate thalassemia trait and IDA Table 1.4 in: Kjeldsberg, Carl R.; Perkins, Sherrie L.. Though for fun let's look… University of Minnesota School of Medicine and School of Dentistry. Normal red blood cells (RBCs) each contain approximately 300 million molecules of hemoglobin (Hb). Hb electrophoresis. FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Check out the most common problems in pathology, Thank you a lot Normal reference range of RDW-CV in human red blood cells is 11.5–15.4%. Mon - Sat from 11 am - 2 pm; Closed Sun. [citation needed] High RDW. I am really thankful for the good, simple and clear explanation. American Society for Clinical Pathology. The Mentzer index which is defined as mean corpuscular volume per red cell count. If Mentzer index is lower than 13, thus beta thalassemia is more likely. Mild microcytic anemia may be treated presumptively with oral iron therapy in children six to 36 months of age who have risk factors for iron de… (MCV, RDW, Haemoglobin are CBC based values). Hello guys.. FORMULA—, Where- DF= Discriminent Function According to Youden's index, Shine & Lal and RBC count showed the greatest diagnostic value in patients younger than 10 years and RDW and RBC count indices in those older than 10 years. An index of less than 13 suggests that the patient has the thalassemia trait, and an index of more than 13 suggests that the patient has iron deficiency. However, "width" refers to the width of the volume curve (distribution width, here presented as the coefficient of variation, or CV), not the width of the cells. Thank you for everything you do. An index of less than 13 suggests that the patient has the thalassemia trait, and an index of more than 13 suggests that the patient has iron deficiency. Mentzer index that is greater than 13, thus iron deficiency anaemia is more likely. High diagnostic accuracy in distinguishing Thalassemia with iron deficiency anemia was RDW index (88.14%), and followed by Mentzer index (86.85%). Your email address will not be published. Red blood cell distribution width (RDW or RDW-CV or RCDW and RDW-SD) is a measure of the range of variation of red blood cell (RBC) volume that is reported as part of a standard complete blood count. [3], The "width" in RDW-CV is sometimes thought to be "misleading", since it in fact is a measure of deviation of the volume of RBCs, and not directly the diameter. Usually red blood cells are a standard size of about 6–8 μm in diameter. A low Mentzer Index, calculated from CBC data [MCV/RBC < 13], may suggest this disorder but a hemoglobin electrophoresis would be diagnostic.
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