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• W2046088435 abstract "Hypochromic microcytic anemias are frequently encountered in clinical practice. In most cases they are due to iron deficiency, but in some geographical areas other disorders, such as the β-thalassemia trait (β-TT), must be considered [1, 2]. β-Thalassemia is a genetically determined disorder in which the defect in the β-globin gene results in a decreased production of hemoglobin (Hb) A1. Clinically, the disease exists in two forms: β-thalassemia minor (heterozygous β-TT) and β-thalassemia major (homozygous β-TT). β-Thalassemia is frequently seen in Mediterranean countries, Africa and Asia and it is an important public health problem [3]; its prevalence was found to be 10.2% in Antalya [4].β-TT is generally asymptomatic; however, in clinical practice, because there is hypochromic microcytic mild anemia and the peripheral smear resembles iron deficiency anemia (IDA), these two disorders must be distinguished from each other [5]. Some differential indexes were defined by calculating red blood cell (RBC) indexes and were used for rapid discrimination between TT and IDA, but there is also some information in the literature about platelet indexes in these two diseases [6]. The aim of this study is to evaluate platelet indexes in patients with IDA and β-TT, and the basic question was whether the determination of these indexes might help in the discrimination between IDA and β-TT.Forty-nine patients (45 female, 4 male, median age 39 years) with IDA, 57 patients with β-TT (44 female, 13 male, median age 39 years) and 41 healthy subjects (median age 50 years) were included in the study. All the patients gave their informed consent to participate in the study. The patients who had IDA and β-TT were selected in such a way that there were no statistically significant differences between the Hb values of the two groups (p = 0.11). Patients with other causes of anemia (folic acid, B12 deficiency with IDA or folic acid, B12 and/or iron deficiency with β-TT) were excluded.Venous blood was collected into EDTA and citrate-anticoagulated tubes (1 vol citrate/9 vol blood) after an overnight fast. The complete blood cell count and platelet indexes [mean platelet volume (MPV), platelet distribution width (PDW)] were measured by automated cell counter (Abbot Cell-Dyn 3500). Serum iron, iron binding capacity, ferritin, folic acid, vitamin B12, Hb electrophoresis (agarose gel electrophoresis) and quantitative HbA1, A2 and F levels were also determined. The definition of the World Health Organization which includes an Hb concentration below 12 g/dl in women and 13 g/dl in men was used for the diagnosis of anemia. If a low serum ferritin level (<4 ng/ml for women, <12 ng/ml for men) was associated with anemia (mostly hypochromic microcytic) IDA was diagnosed. β-TT was diagnosed if HbA2 and/or HbF levels were increased. Specific etiologic tests were done after the diagnosis of IDA but we could not perform molecular diagnostic tests.SPSS 10 for Windows was used for the statistical analysis. The test distribution was determined by the Kolmogorov-Smirnov test and Student’s t test for normal distribution and the Mann-Whitney U test was used if the distribution was not normal. The results were given in mean ± SD. p < 0.05 was considered to be statistically significant. MedCalc statistical software was used for receiver operating curve (ROC) analysis between the two patient groups. Platelet count, MPV, and PDW were found to be significantly different between the two patient groups. The results of patients and the control group are given in table 1.In the literature there are numerous studies about RBC indexes in IDA and TT but there are only a few reports about platelet indexes in β-TT [6, 7]. The increase in platelet count and the decrease in RBC has long been known in IDA and in practical medicine we sometimes use these parameters to differentiate IDA from β-TT. Herein we also found significantly elevated platelet counts in IDA and according to ROC curve analysis sensitivity was found to be 82.5% and the discriminating value was 310 × 109/l.It was previously reported that the increased production and destruction of platelets caused elevation of the MPV values [8]but in the hemogram we can detect increased MPV levels in myelodysplastic syndromes and myeloproliferative disorders. Additionally hypercholesterolemia, diabetes mellitus, erythropoietin and estrogen intake can also elevate MPV values [9, 10, 11, 12]. In the present study both MPV and PDW were found to be significantly elevated in the β-TT group compared to the IDA group and healthy subjects. According to ROC curve analysis the discriminating value was found to be 18 for PDW (sensitivity: 68.4%) and 11 for MPV (sensitivity: 61.4%). The elevated PDW may be secondary to MPV elevation and we can suggest the following: (1) Peripheral destruction of RBC may cause an increase of erythropoietin levels and this may induce accelerated platelet production [13].](2) Folic acid deficiency may be another cause. In the present study we determined serum folic acid levels which were all normal. (3) Some of the patients may have splenomegaly and accelerated platelet sequestration in the spleen may be another reason; however, according to the physical examination none of the patients had palpable splenomegaly. In conclusion, the platelet counts, MPV and PDW values can be used to distinguish between β-TT and IDA patients." @default.
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• W2046088435 title "The Importance of Platelet Indexes in Discriminating between β-Thalassemia Trait and Iron Deficiency Anemia" @default.
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• W2046088435 doi "https://doi.org/10.1159/000077575" @default.
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