Discriminant analysis of iron deficiency anaemia and heterozygous thalassaemia traits: A 3-dimensional selection of red cell indices

Abstract

The two main causes of microcytic and hypochromic anaemia are iron deficiency and thalassaemia traits. Discriminant analysis based on a simple combination of classical red cell indices have been used to differentiate between iron deficiency anaemia and thalassaemia with varying degree of accuracy. Two new indices are now available from modern cell counters: red cell distribution width (RDW) and haemoglobin concentration distribution (HDW). Our discriminant analysis suggests that RBC, MCHC and RDW contribute significantly to the differentiation between iron deficiency anaemia and thalassaemia in both healthy donors and hospital-patient groups. In the discriminating process, previous workers have overlooked the heterogeneity of anaemia between anaemic groups as well as biological differences in MCV and MCH among the α and β thalassaemia subjects. This study took into account of these biases and proved, for the first time, that differentiation between iron deficiency and thalassaemia by discriminant analysis was clinically reliable and not significantly biased by the severity of anaemia. The diagnostic accuracy of discriminant analysis was confirmed retrospectively by the reallocation algorithm using the jack-knife principle and prospectively by testing the discriminant functions on independent new samples. Selection of the red cell indices contributing to the discrimination of microcytic hypochromic anaemia was based on biological and statistical considerations. The clear separation of red cell index data of iron deficiency anaemia and thalassaemia traits was shown 3-dimensionally by surface plots.