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Original ArticleOpen Access
Red Cell Indices and Therapeutic Trial of Iron in Diagnostic Work-Up for Anemic Thai Females
Nuchprayoon I 
,
Sukthawee B ,
Nuchprayoon T
,
Sukthawee B ,
Nuchprayoon T Anemia is common among Thai females. Thalassemia and iron deficiency are highly pre-
valent in the Thai population. A therapeutic trial of iron has been used to differentiate between the two
conditions, however, no previous study on its usefulness in a Thai population has been reported.
Otherwise healthy persons who had complete blood count (CBC) as routine 'check-up' and found to
be anemic (Hb
<
12 g/dl) at a preventive medicine clinic were tested for hemoglobin typing, serum
ferritin, serum iron, and were given oral iron sulfate (120 mg elemental iron per day for at least 2
months) and a repeat CBC on a follow-up visit. Sixty-six individuals, all females, with pre-treatment
hemoglobin (Hb) level of 9.5 เธ‘ 1.7 g/dl (meanเธ‘ SD), had complete data for analysis. Final diagnoses
were isolated iron deficiency in 23 (34.8% ), iron deficient thalassemia traits in 6 (9.1%) and iron-
sufficient thalassemia syndromes in 29 (43.9%) anemic subjects. After a therapeutic trial of iron, Hb
rose to 12.8 เธ‘ 1.0 g/dl (n
=
16, p
=
2 x 10เธ—8
)
among the iron deficient group, but not in thalassemia. The
authors have identified that the most useful red cell indices that will discriminate between iron defi-
ciency and thalassemia is a combination of red blood cell counts (RBC)
>
4.4 x l06/J..l1 and mean corpus-
cular volume (MCV) < 69
fl.
High RBC (> 4.4 x 106/J..ll) and very low MCV (< 69
fl)
is a sensitive
(92.9%) and highly specific ( 100%) criteria for diagnosis of mild thalassemia diseases (Hemoglobin H
(HbH), Hemoglobin H-Constant Spring (HbH-CS), and homozygous Hemoglobin E (HbEE)). Con-
versely, a low RBC (> 4.4 x 106/J..ll) and/or low to normal MCV (69-85
fl)
is highly sensitive (91.3%)
but not specific (60%) for the diagnosis of iron deficiency. The authors conclude that a therapeutic trial
of iron is useful as a diagnostic test in anemic females except those with high RBC (> 4.4 x 106/J..1.1)
and very low MCV ( < 69
fl),
a subgroup which most likely has thalassemia and are least likely to benefit
from iron treatment.
Key word : Anemia, Red Cell Indices, Iron Deficiency, Thalassemia, Therapeutic Trial of Iron
valent in the Thai population. A therapeutic trial of iron has been used to differentiate between the two
conditions, however, no previous study on its usefulness in a Thai population has been reported.
Otherwise healthy persons who had complete blood count (CBC) as routine 'check-up' and found to
be anemic (Hb
<
12 g/dl) at a preventive medicine clinic were tested for hemoglobin typing, serum
ferritin, serum iron, and were given oral iron sulfate (120 mg elemental iron per day for at least 2
months) and a repeat CBC on a follow-up visit. Sixty-six individuals, all females, with pre-treatment
hemoglobin (Hb) level of 9.5 เธ‘ 1.7 g/dl (meanเธ‘ SD), had complete data for analysis. Final diagnoses
were isolated iron deficiency in 23 (34.8% ), iron deficient thalassemia traits in 6 (9.1%) and iron-
sufficient thalassemia syndromes in 29 (43.9%) anemic subjects. After a therapeutic trial of iron, Hb
rose to 12.8 เธ‘ 1.0 g/dl (n
=
16, p
=
2 x 10เธ—8
)
among the iron deficient group, but not in thalassemia. The
authors have identified that the most useful red cell indices that will discriminate between iron defi-
ciency and thalassemia is a combination of red blood cell counts (RBC)
>
4.4 x l06/J..l1 and mean corpus-
cular volume (MCV) < 69
fl.
High RBC (> 4.4 x 106/J..ll) and very low MCV (< 69
fl)
is a sensitive
(92.9%) and highly specific ( 100%) criteria for diagnosis of mild thalassemia diseases (Hemoglobin H
(HbH), Hemoglobin H-Constant Spring (HbH-CS), and homozygous Hemoglobin E (HbEE)). Con-
versely, a low RBC (> 4.4 x 106/J..ll) and/or low to normal MCV (69-85
fl)
is highly sensitive (91.3%)
but not specific (60%) for the diagnosis of iron deficiency. The authors conclude that a therapeutic trial
of iron is useful as a diagnostic test in anemic females except those with high RBC (> 4.4 x 106/J..1.1)
and very low MCV ( < 69
fl),
a subgroup which most likely has thalassemia and are least likely to benefit
from iron treatment.
Key word : Anemia, Red Cell Indices, Iron Deficiency, Thalassemia, Therapeutic Trial of Iron
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