Diagnostic Significance of the Mentzer Index, Shine & Lal In

RBC PRODUCTION

BLOOD:

(Hoffman, 2014)

RBC METABOLISM

HEXOSE MONOPHOSPHATE

PATHWAY

(Rodak et al., 2016)

HEMOGLOBIN

(Rodak et al., 2016)

RAPOPORT-

LUEBERING

PATHWAY

METHEMOGLOBIN

REDUCTASE

PATHWAY

HEMOGLOBIN SYNTHESIS

(Rodak et al., 2016)

(Holm and Kim, 2016)

THALASSEMIA

HEMOGLOBIN

DEFECTS

HEMOGLOBINOPATHY

THALASSEMIA

Diagnostic Significance of the Mentzer, Shine & Lal, Green & King and England & Fraser Indices in the Differential Diagnosis of Alpha and Beta-Thalassemia

among Filipino Patients

in a Tertiary Hospital

SYMPTOMS:

BETA

THALASSEMIA

ALPHA

THALASSEMIA

Acosta, Sharysse Pearl J.

Bermillo, Norman Duaine E.

Creencia, John Francis D.J.

Daroy, Crystel Mhariel V.

Espino, Leandro L.

Guico, Patricia O.

Guieb, Michaela Gabrielle G.

4C-Medical Technology

EPIDEMIOLOGY

1.7%

Beta thalassemia minor

Beta thalassemia major

Asst. Prof. Ron Christian G. Sison, RMT, MT(AMT), MLS (ASCPi), MPH

Thesis Adviser

THALASSEMIA BELT

Alpha-thalassemia major

Alpha-thalassemia minima

(Muncie & Campbell, 2009)

Alpha-thalassemia

5%

Beta-thalassemia

1-9%

(Fucharoen, 2011)

CHROMOSOME 16

CHROMOSOME 11

(Muncie & Campbell, 2009)

Hemoglobin H

disease

Beta thalassemia intermedia

Alpha-thalassemia trait

(Galanello and Cao, 2011)

(John Hopkins Medicine, n.d.)

INDICES

Mentzer Index

SPECIFIC OBJECTIVES:

Shine & Lal Index

2.) To assess the specificity of the indices in establishing true negative A-T and B-T in congruence with the Alpha and Beta-globin genotyping

1.) To assess the sensitivity of the indices in establishing true positive A-T and B-T in congruence with the Alpha and Beta-globin genotyping

GENERAL OBJECTIVES:

4.) To identify the most sensitive and specific index based on the determined cutoff values appropriate for Filipino patients

3.) To identify appropriate cutoff values for each of the indices in determining the most reliable index suitable for the screening of suspected A-T and B-T Filipino patients

Green & King Index

• To determine the predictive capacity of Mentzer, Shine & Lal, Green & King and England & Fraser indices in relation with Hemoglobin A (HbA ) levels among patients diagnosed with A-T and B-T

2

England & Fraser Index

Thank you

for listening!

ACKNOWLEDGEMENT

Prof. Ron C. G. Sison, RMT, MPH

Prof. Xandro Alexi A. Nieto, M.Ed.

Krizzia Allyssa Cotingjo, RMT

Family and Friends

Almighty Father

INDICES

SIGNIFICANCE

OF THE

STUDY

1. Future researchers

2. Academe

3. Practice of Medical Technology

4. Government Agencies relating to

Health and to the Non-Profit

Organizations

5. General Public

Green & King

Mentzer

MCV^2 x RDW

--------------------

Hb x 100

MCV/RBC

< 13

< 65

METHODOLOGY

THESIS PROPOSAL

RECOMMENDATIONS

RESEARCH DESIGN

England & Fraser

Shine & Lal

MOCK DEFENSE

Use freshly acquired samples for testing

MCV - RBC - (5 x Hb) - 3.4

Grouping of sample population by age and gender

MCV^2 x MCH

---------------------

100

Specific types of A-T and B-T

< 0

Add more indices

< 1530

Differentiation of A-T and

iron deficiency anemia

Conclusion

EXCLUSION/INCLUSION CRITERIA

• Exclusion

-Patients with concomitant IDA or other microcytic anemia

• Inclusion

-Patients from December 2014 until October 2016 who were diagnosed with A-T or B-T by globin genotyping, regardless of their age and gender

- With HbA results of less than 2.3% or greater than 3.5%

- Must have CBC results (Hemoglobin, MCV, MCH, RDW, RBC count)

2

Alpha-thalassemia

Most sensitive

Shine & Lal Index (< 1259.58; p = 0.002)

Most specific

Mentzer Index (< 13.17; p = 0.001)

Beta-thalassemia

Most sensitive

Green & King Index (< 71.72; p = 0.026)

Most specific

Shine & Lal Index (< 942.69; p = 0.001)

ANALYSIS OF DATA

Sensitivity and Specificity of the four diagnostic indices based on cutoff values set by different researches

Sensitivity and specificity of the established cutoff values of the

four diagnostic indices for Alpha-thalassemia

Sensitivity and specificity of the established cutoff values of the

four diagnostic indices for Beta-thalassemia

MKmisc package

version 0.993 of R 3.3.1

ROC curve and AUC for Beta-thalassemia

ROC curve and AUC for Alpha-thalassemia

REFERENCE LINE

BLANK ROC CURVE

Comparison of the Sensitivity and Specificity of the Indices based on the cutoff values set by different researches and established cutoff values of Alpha-thalassemia patients

Comparison of the Sensitivity and Specificity of the Indices based on the cutoff values set by different researches and established cutoff values of Beta-thalassemia patients

SAMPLE SIZE

AUC VALUES

Shine and Lal

Index

Mentzer

Index

Shine and Lal

Index

Beta-thalassemia

England and Fraser

Index

Green and King

Index

England and Fraser

Index