Índice de Mentzer como adjuvante no diagnóstico diferencial da talassemia beta heterozigota e anemia ferropriva

Eduardo Roman Pedro; Cristiane da Silva Rodrigues Araujo; Guilherme Loronha Bertoncelo; Luciano Oliveira Siqueira

doi:10.23925/1984-4840.2023v25a3

Authors

Eduardo Roman Pedro Universidade de Passo Fundo
Cristiane da Silva Rodrigues Araujo Universidade de Passo Fundo
Guilherme Loronha Bertoncelo Universidade de Passo Fundo
Luciano Oliveira Siqueira Universidade de Passo Fundo

DOI:

https://doi.org/10.23925/1984-4840.2023v25a3

Keywords:

Anemia, Iron-deficiency, Beta-thalassemia, Diangosis, differential, Genetic counseling, Cross-sectional studies

Abstract

The aim of the present study was to analyze the Mentzer Index as an adjuvant in the diagnosis of the thalassemia trait of beta-thalassemia, given that, in its homozygous form, beta thalassemia has a clinical setting that is distinct from iron deficiency anemia or even from the beta-thalassemia trait, culminating in a hemolytic anemia with symptoms of excessive hemolysis leading to splenomegaly, anemia with significant hemoglobin deficiency, bone marrow hyperplasia and, in some cases, imminent need for blood transfusion. This is an integrative review of the Mentzer index. A bibliographic review was carried out in the electronic databases PUBMED, SciELO and Periódicos CAPES between 2016 and 2021. 12 manuscripts to be reviewed were incorporated in the present study, which needed to relate the Mentzer index to the differentiation of beta-thalassemia trait from anemia ferropenic. After reading and analyzing the articles related to this study, it was shown that the Mentzer index can be recommended for differentiating between the two pathologies with good sensitivity and specificity for the trait related to beta-thalassemia, however, in case of doubts between anemia iron deficiency and beta-thalassemia, a study with hemoglobin electrophoresis should be performed. Therefore, it is concluded that in the absence of the possibility of carrying out hemoglobin electrophoresis or hemoglobin analysis by HPLC, the Mentzer index can be used to differentiate between iron deficiency anemia and the respective beta-thalassemia trait and start treatment, however, it is necessary to to point out that in the absence of response to therapy, hemoglobin electrophoresis ...

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

De Santis GC. Anemia: definição, epidemiologia, fisiopatologia, classificação e tratamento. Medicina (Ribeirão Preto). 2021;52(3):239-51. doi: 10.11606/issn.2176-7262.v52i3p239-251

Origa R. β-Thalassemia. Genet Med. 2017;19(6):609-19. doi: 10.1038/gim.2016.173.

Machado IE, Malta DC, Bacal NS, Rosenfeld LGM. Prevalência de anemia em adultos e idosos brasileiros. Rev Bras Epidemiol. 2019;22(Suppl 2). doi: 10.1590/1980-549720190008.supl.2

Rosenfeld LG, Bacal NS, Cuder MAM, Silva AG, Machado IE, Pereira CA, et al. Prevalência de hemoglobinopatias na população adulta brasileira: Pesquisa Nacional de Saúde 2014-2015. Rev Bras Epidemiol. 2019;22(Suppl 02). doi: 10.1590/1980-549720190007.supl.2

Brasil Imigrantes italianos: entre a italianità e a brasilidade [Internet]. [acesso em: 15 nov. 2021]. Disponível em: https://brasil500anos.ibge.gov.br/territorio-brasileiro-e-povoamento/italianos.

Brasil. Ministério da Saúde. Orientações para diagnóstico e tratamento das Talassemias Beta [Internet]. Brasília: Ministério da Saúde; 2016 [acesso em: 15 nov. 2021]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/orientacoes_diagnostico_tratamento_talassemias_beta.pdf. 2016

Failace R, Fernandes FB, Failace R. Hemograma: manual de interpretação. 6ª ed. Porto Alegre: Artmed; 2015. p.167-77.

Jimenez K, Kulnigg-Dabsch S, Gasche C. Management of iron deficiency anemia. Gastroenterol Hepatol (NY). 2015;11(4):241-50.

Kohne E. Hemoglobinopathies: clinical manifestations, diagnosis, and treatment. dtsch Ärztebl Int. 2011;108(31-32):532-40. doi: 10.3238/arztebl.2011.0532.

Bejaoui M, Naouel G. Beta Thalassemia major in a developing country: epidemiological, clinical and evolutionary aspects. Mediterranean J Hematol Infect Dis. 5.1 2013:e2013002. doi: 10.4084/MJHID.2013.002.

Shafique F, Ali S, Almansouri T, Van Eeden F, Shafi N, Khalid M, et al. Thalassemia, a human blood disorder. Braz J Biol. 2023;83. doi: 10.1590/1519-6984.246062.

Fibach E, Rachmilewitz EA. Pathophysiology and treatment of patients with beta-thalassemia - an update. F1000 Res. 2017,6:2156. doi: 10.12688/f1000research.12688.1.

Magro F, Ribeiro R, Sekine L, Marinato A, Nabhan S, Stefani S, et al. Cost of chronic red blood cell transfusion in the Brazilian private healthcare sector from a payer perspective. J Bras Econ Saúde. 2020;12(3):226. doi: 10.21115/JBES.v12.n3.p226-30.

Instituto Brasileiro de Geografia e Estatística (IBGE). Marau [Internet]. 2021 [acesso em: 23 nov. 2021]. Disponível em: https://cidades.ibge.gov.br/brasil/rs/marau/panorama

Sain A, Bhake A, Agrawal A, Thomas S. Discriminant red cell indices for microcytic hypochromic anaemia in distinguishing beta thalassaemia trait and iron deficiency anaemia: a systematic review. J Clin Diagn Res. 2021;15(1):ee01-6. doi: 10.7860/JCDR/2021/43521.14458.

Amid A, Haghi-Ashtiani B, Kirby-Allen M, Haghi-Ashtiani M. Screening for thalassemia carriers in populations with a high rate of iron deficiency: revisiting the applicability of the Mentzer Index and the effect of iron deficiency on Hb A2 levels. Hemoglobin. 2015;39(2):141-4. doi: 10.3109/03630269.2015.1024321

Fisberg M, Lyra I, Weffort V, coordenadores. Consenso sobre anemia ferropriva: mais que uma doença, uma urgência médica! Diretrizes SBP. 2018;(2):2-12.

Alam S, Purnamasari R, Bahar E, Rahadian K. Mentzer index as a screening tool for iron deficiency anemia in 6-12-year-old children. Paediatr Indonesiana. 2014;54(5):294-8 doi: 10.14238/pi54.5.2014.294-8.

Vehapoglu A, Ozgurhan G, Demir AD, Uzuner S, Nursoy MA, Turkmen S, et al. Hematological indices for differential diagnosis of Beta thalassemia trait and iron deficiency anemia. Anemia. 2014 2014:576738. doi: 10.1155/2014/576738.

Arora S, Rana D, Kolte S, Dawson L, Dhawan I. Validation of new indices for differentiation between iron deficiency anemia and beta thalessemia trait, a study in pregnant females. Int J Sci Reports. 2018;4(2):26. doi: 10.18203/issn.2454-2156.IntJSciRep20180394.

Siswandari W, Rujito L, Indriani V, Djatmiko W. Mentzer Index diagnostic value in predicting thalassemia diagnosis. IOP Conf Ser Earth Environ Sci. 2019;255(1): 012004. doi: 10.1088/1755-1315/255/1/012004.

Ahmed HS, Hashem EA, Mahmoud AA. The diagnostic performance of red cell distribution width and Mentzer Index for discrimination between iron deficiency anemia and beta thalassemia trait. Med J Cairo Univ. 2018;86(12):3979–88. doi: 10.21608/mjcu.2018.62193.

Zafar M, Tabassum A, Cheema QA, Mazhar SB. Role of red cell distribution width and Mentzer Index in differentiating iron deficiency anemia from anemia due to β thalassemia trait. J SAFOG. 2019;11(5):297–300. doi: 10.5005/jp-journals-10006-1718.

Munir AH, Ali K, Khan MI, Sultana N, Khan SZ. Mentzer Index as a diagnostic tool for screening thalassemic patients and differentiating iron deficiency anemia from thalassemia. J Khyber Coll Dentistry. 2019;9(04):103-6. doi: 10.33279/jkcd.v9i04.406.

Bose S, Maimoon S. Is Mentzer Index a reliable diagnostic screening tool for beta thalassemia trait? IOSR J Dent Med Sci. 2018;17(6):7–11. doi: 10.36347/SJAMS.2020.V08I12.026.

Ahmad S, Zaidi N, Mehdi SR, Irfan S, Ahmad S. Indices in differentiating iron deficiency anemia from thalassemia trait- a comparative study. Asian J Med Sci. 2021;12(10):81–6. doi: 10.3126/ajms.v12i10.38268.

Surjawan Y, Tan HL, Setiabudy RD, Rositawati W. Early screening of hemoglobinopathy in Indonesia using erythrocyte indices. Indones Biomed J. 2017;9(2):99–105. doi: https://doi.org/10.18585/inabj.v9i2.313.

Gopchade DA. Mentzer Index for differential diagnosis of iron deficiency anaemia and beta thalassemia trait. J Med Sci Clin Res. 2017;04(12):15138–42. doi: 10.33314/jnhrc.v21i1.4479.

Oltean A, Chincesan IM. Mentzer Index in pediatric thalassemia trait. Jurnalul Pediatrului. 2020;XXIII(89–90):35–40. doi: 10.37224/JP.2020.8990.07.

Sahiratmadja E, Seu MMV, Nainggolan IM, Mose JC, Panigoro R. Challenges in thalassemia carrier detection in a low resource setting area of eastern Indonesia: the use of erythrocyte indices. Mediterr J Hematol Infect Dis. 2021;13(1):2–5. doi: 10.4084/MJHID.2021.003.

Saxena DS, Jain DR. Evaluation of the diagnostic reliability of Mentzer index for Beta thalassemia trait followed by HPLC. Trop J Pathol Microbiol. 2020;6(2):124–9. doi: 10.17511/jopm.2020.i02.03.