Combined detection of erythrocyte and reticulocyte to improve screening efficiency of thalassaemia trait in pregnancy

Abstract

Objective

Both iron deficiency anemia (IDA) and thalassaemia trait (TT) are indistinguishable in pregnancy. This study aimed to establish some new hematological indices based on erythrocyte and reticulocyte parameters to distinguish each other.

Methods

A total of 425 anemic pregnant women including 177 cases with IDA, 105 cases with α-TT, and 143 cases with β-TT were enrolled in the study and divided into two groups: development and validation groups. Logit-P1 (for identifying TT from IDA) and logit-P2 equations (for distinguishing between α-TT and β-TT) were designed in the development group, and their diagnostic performances were compared with 12 previous hematological indices in the validation group.

Results

The optimal cut-off value, sensitivity, sensitivity of logit-P1 were 0.84, 85.9%, 55.9%, and those of logit-P2 were 0.41, 85.9%, 55.9%. Compared to 12 hematological indices, logit-P1 (AUC = 0.765) and logit-P2 (AUC = 0.919) provided optimal identification performances within respective application ranges (P < 0.001). In combination with the supplementary criteria (RBC#≥4.1 × 10¹²/L), the two equations had low missed diagnosis rate and high accuracy rate for α-TT carriers (6.3% and 79.4%) and β-TT carriers (4.7% and 81.4%), and showed moderate agreement with clinical diagnosis (Kappa = 0.540).

Conclusion

For screening TT in anemic pregnant women, reticulocyte detection should be taken into account. The hematological indices based on erythrocyte and reticulocyte parameters would be superior to those only calculated by erythrocyte parameters.