RDW A discriminative index in differentiation of microcytic hypochromic anemia in children below five years.

Dr.Vijay Suri; Dr. Sonali Solanki; Dr. Rajinderjit Singh Ahi; Dr. Ashwani Maheshwari; Dr.Anshul Gupta; Dr. Arnav Kr. Roychoudhury

Volume : VI, Issue : VI, June - 2017

RDW A discriminative index in differentiation of microcytic hypochromic anemia in children below five years.

Dr. Vijay Suri, Dr. Sonali Solanki, Dr. Rajinderjit Singh Ahi, Dr. Ashwani Maheshwari, Dr. Anshul Gupta, Dr. Arnav Kr. Roychoudhury

Abstract :

Background: Anemia is a major public health problem that affects populations in both developed and developing countries and is widely prevalent amongst all the ages. Anemia resulting from lack of sufficient iron to synthesize hemoglobin is the most common hematological disease in infants and children. It has been estimated that 30% of the global population suffers from iron deficiency anemia (IDA), and most of those affected live in the developing countries. Recent NFHS–III (National Family Health Survey– III) surveys (2005–06) have shown that 70–85% (approx. 79.2%) of Indian young children have anemia. Thalassemia is one of the major autosomal recessive hereditary hemoglobinopathies prevalent in the world population, particularly in Mediterranean belt, Far–eastern and South East Asian countries. Thalassemias are a group of hemoglobinopathies caused by genetic mutations of the hemoglobin (Hb) genes, resulting in reduced production or total absence of one or more globin chains. Iron deficiency anemia is the most common microcytic hypochromic anemia worldwide. Anemia resulting from lack of sufficient iron to synthesize hemoglobin is the most common hematological disease in young children and women of reproductive age but it can be found in people of any age–group. It has been estimated that 30% of the global population suffers from iron deficiency anemia (IDA) and most of those affected live in the developing countries like India7. Iron deficiency anemia in adults is caused by loss of blood, while in childhood faulty diet is to blame. Currently, the detection of IDA is largely dependent upon quantification of biochemical markers like serum ferritin (SFr), serum transferrin (STr) and zinc protoporphyrin (ZnPP) which are not routinely available and affordable in developing countries due to high costs. Results & Observation. In the present study, Mentzer Index ((MI) had a sensitivity of 71.91 and 84.62 % for IDA and BTT respectively. The specificity of MI for IDA and BTT was 84.62% and 71.91% respectively. The PPV of MI for IDA and BTT was 94.12% and 46.81% respectively while the NPV of MI for IDA and BTT was 46.81 and 94.12% respectively. we can conclude that RBC count >4.69 million/mm3 and MCV< 62.9 fL favours the diagnosis of BTT while RBC count <4.69 million/mm3 and MCV >62.9 fL favours IDA. Conclusion: All these red blood cell indices i.e. RDW, Mentzer Index, England and Fraser index can be used as good discriminative indices between IDA and BTT. They can be used to differentiate microcytic anemias into IDA and BTT, where HPLC and iron studies (S. ferritin, S.iron, TIBC) cannot be done due to factors like unavailability or high cost. Though hemoglobin studies and iron profile still remain the gold standard. However, preliminary screening of microcytic hypochromic anemia cases on routine complete blood count report with the help of RBC count, RDW, Mentzer index and England & Fraser Index can avoid unnecessary iron therapy in children with suspected BTT as it may cause iron overload and systemic damage.