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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
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
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
MKmisc package
version 0.993 of R 3.3.1
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