10th June final thal prediction

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The “Thal-index” with the BTT prediction.exe to discriminate b thalassaemia traits from other microcytic anaemias.:

The “Thal-index” with the BTT prediction.exe to discriminate b thalassaemia traits from other microcytic anaemias. Nishad AAN , Wickramasinghe AR, Pathmeswaran A , Premawardhena AP . Faculty of Medicine , University of Kelaniya . Sri Lanka

Introduction:

Introduction b -thalassemia trait (BTT) is a common cause of hypo-chromic microcytic anemia. In Sri Lanka 3% of population are carriers for b -thalassemia while over 20% are estimated to have iron deficiency. The gold standard for diagnosis of BTT is HPLC( High performance liquid chromatography) However the technology is limited to only a few centres in the island

Introduction:

Introduction Automated blood count analyzers are more widely available. Attempts have been made to predict the diagnosis of BTT based on red cell indices. Low specificity has been the major limitation.

Introduction:

Introduction Discriminant analysis is a statistical method used to develop a predictive model of group membership based on observed characteristics of each case ( eg: cause of anaemia based on red cell indices)

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We developed a new formula using the RBC parameters which would effectively differentiate BTT from other causes of low MCV which we named “ Thal index”

Materials and methods :

Materials and methods From November 2008 to March 2010. Thalassaemia unit at Ragama. MCV less than 80 fl. Complete blood counts- ( Beckman coulter A C .T diff.2 TM analyzer 2002). HPLC ( BioRad Variant analyzer 2000). HbA2 level >= 3.5% was considered as BTT

Materials and methods:

Materials and methods RBC indices were compared and significances were calculated. (RBC count, hemoglobin level, HCT, MCV, MCH, MCHC, and RDW). Stepwise multivariate discriminant analysis determined those indices that best differentiated BTT from other causes.

Materials and methods:

Materials and methods Sensitivity and specificity was calculated. The new index cut off point- by plotting a Receiver Operating Characteristics curve. Computer program developed to get the thalassaemia status directly from three RBC indices

Results:

Results 326 samples with microcytosis assessed. 232 BTT samples (based on HPLC)

The significance of RBC parameters between BTT and other Microcytic anaemias. :

The significance of RBC parameters between BTT and other Microcytic anaemias .

Results:

Results “Thal index” = (0.615 x MCV) + (0.518 x MCH) + (0.446 x RDW) The “Thal index” identified 59.0 as the cutoff where 59 or below identifies BTT. Sensitivity = 90% and specificity = 85%.

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18 26 75

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14 21 66

Comparison of different indices used in the study. :

Comparison of different indices used in the study.

Discussion:

Discussion BTT prediction.exe is fast and a simple tool to predict the β-Thalassaemia status which is superior to the presently used formulas This is the first available computer soft ware to diagnose BTT based on red cell indices.

Acknowledgements:

Acknowledgements Mr. Lakshman, Mr. Suran and Mr. Rexon at Thalassaemia lab , Ragama. Mr. I Solangaarachchi and S. Hettige at Computer centre , Medical Faculty, University of Kelaniya.

Acknowledgements :

Acknowledgements

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Thank You !

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