الفهرس 
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Abstract
Iron deficiency anemia (IDA) and β-TT are two of the most common causes of microcytic, and hypochromic anemias worldwide.
Because of similar red blood cell count parameters and blood picture, it was imperative to develop other measures that would differentially and correctly diagnose these two anemias.
Several mathematical formulas and simple Red blood cell indices and formulas have been introduced as simple, fast and inexpensive means of providing differential diagnosis for IDA and β-TT in school children.
The Objective of this study was to apply and compare 23 well-documented discriminant functions on a population of 200 confirmed children with microcytic anemias (IDA n = 177, and β-TT n =23) aged between 6 months and 16 years.
Red cell indices derived from automated red cell analyzers were used to evaluate the following discriminant indices and formulas:
Mentzer index (MI), Modified Mentzer index (MmI), RDWI, Shine and Lal, Srivastava index, Green and King index (G&KI), Sirdah index, Ehsani index, England and Fraser index (E&FI), Ricerca index, MDHL, MCHD, Keikhaei index, Sirachainan index, Bordbar et al. index, Differentiating score (DS), Huber-Herklotz Index (HHI), Kerman Index 1,Kerman Index 2, Hisham Index (HiI), Hameed Index (HaI), Bessman index (RDW count), and RBCs count.
Sensitivity (SENS), specificity (SPEC), positive and negative predictive value, and Youden’s Index (YI) were evaluated.
The results show that Kerman Index 1 had the highest Youden’s Index value (61.02%) in correctly differentiating between IDA and Β-TT, while was found Sirachainan et al, Huber-Herklotz Index (HH), and RDW as a discriminative function show the worst Youden index (0.0%, -1.69%, and -5.65% respectively) and ineffective in differentiating between microcytic anemias in our population.
Kerman Index 1 Index showed with great sensitivity (100%) but not great specificity (61.02%) to be the best discriminant function to differentiate between IDA and β-TT cases.
Sirachainan et al index shows the best specificity (100%) to differentiate between IDA and β-TT cases.
For each index or formula ROC curves were constructed to calculate the area under the curve (AUC).
RBCs count as a discriminative function showed the highest reliability, as it had the largest area under the curve (AUC= 0.827 cm2), whereas Differentiating score for male, and RDW as a discriminative function showed the lowest reliability (AUC= 0.563cm2, and 0.55cm2, respectively).
And according to the new optimum cut-off values the highest YI was obtained with Sirdah et al index which increase from 40.01% to 61.6%.
Conclusion:
The wide spectrum of β chain molecular alterations in the world and the degree of anemia may influence the discrimination function and reliability of RBC indices and formulas. The evaluation of iron status and measurement of HbA2 remain the most reliable investigations to differentiate between β-TT and ID subjects.
Although one cannot reach a definitive diagnosis of IDA or βTT based merely on the discriminant functions, these simple calculations are potentially useful in screening patients with microcytic anemia. These indices are a useful tool in the doctor’s guidance about the initial approach to be adopted, but do not relieve patient monitoring that may eventually require confirmatory tests to elucidate the strong suspicion initially raised by the application of these simple indices.
Furthermore, these formulas can be the only differential tool in situations where other specific confirmatory tests are not available.
None of the DFs shows the sensitivity and specificity of 100%.
The present study indicates that Kerman Index 1, Mentzer index (MI), Ehsani et al index, Modified Mentzer index, Kerman Index 2, and RBCs count are the highest reliable discriminator indices in differentiating of β-TT and IDA in sohag country.
Conversely Differentiating score for male, MCHD, Shine and Lal, Hameed Index, Sirachainan et al, Huber-Herklotz Index (HH), and RDW as a discriminative function appear ineffective in our population.The remainders suggest a moderate reliability in distinguishing β-TT and IDA in the population study.