Amarjeet Kaur

Bio: Amarjeet Kaur is an academic researcher. The author has contributed to research in topics: Complete blood count & Hemoglobin A2. The author has an hindex of 3, co-authored 3 publications receiving 103 citations.

Usefulness of Cell Counter-Based Parameters and Formulas in Detection of β-Thalassemia Trait in Areas of High Prevalence

Abstract: The present study aimed to retrospectively evaluate the usefulness of cell counter–based parameters and formulas in β-thalassemia trait (BTT) detection. The study included 170 BTT cases (hemoglobin [Hb]A 2 >4.0% [0.04]) and 30 non-BTT cases (HbA 2 , 2.3%3.5% [0.02-0.04]). Depending on the hemoglobin level and iron deficiency, the BTT group was further classified into classic BTT (n = 112) and BTT with iron deficiency anemia (n = 58). The RBC count, MCH, MCV, RDW, and Shine and Lal, Mentzler, Srivastava, England and Fraser, Ricerca, and Green indexes were applied. For the first time in the population of India, these 10 cell counter parameters and manual formulas were compared with high-performance liquid chromatography–derived HbA 2 levels for deriving a cost-effective alternative method; and receiver operating characteristic curves were applied. We found that the Shine and Lal, Srivastava, and Mentzler indexes, MCV, and MCH have better discriminative function than the RBC count and red cell distribution width and their related formulas. Thalassemia is a genetic disorder affecting synthesis of the globin moiety of the hemoglobin molecule. β-Thalassemia is prevalent in a broad belt extending from the Mediterranean basin to Southeast Asia. It is estimated that 1.5% of the world’s population carries β-thalassemia, ie, at least 80 to 90 million people with an estimated 60,000 new carriers born each year. The Southeast Asian region (which includes India, Thailand, and Indonesia) accounts for about 50% of the world’s carriers, ie, around 40 million people and almost half of homozygous births, whereas in the developed world, Europe and the Americas jointly account for just 10% to 13% of the world’s carriers. 1 The prevalence of β-thalassemia trait (BTT) is about 3.3% in India. In various parts of India, the prevalence of BTT is different: 6.5% in Punjab, 8.4% in Tamilnadu, 4.3% in south India, and 3.5% in Bengal. βThalassemia has a high prevalence in some communities, such as Sindhi, Luvana, Tribes, and Rajputs. The incidence of BTT in Gujarat is 10% to 15% in these communities, whereas the incidence in the general population is 2% to 3%. 2 Because a majority of people with BTT are asymptomatic, they may not be aware of their carrier state. BTT is associated with mild or no anemia but with reduced mean corpuscular volume (MCV) mean corpuscular hemoglobin (MCH) values and an elevated hemoglobin A 2 (HbA 2 ) level. The prevention of this homozygous condition can be

Prevalence Of Haemoglobinopathies In Gujarat, India: A Cross-Sectional Study

Abstract: Various haemoglobinopathies are major public health problem in Gujarat, a state located in the western part of India. The data pertaining to their occurrence and prevalence in the state of Gujarat are scarce and hence it was considered worthwhile to study the burden of haemoglobinopathies in Gujarat, India. A retrospective analysis of blood samples of 428 cases referred to the pathology laboratory from various private practitioners/Government hospitals for the workup of anemia or other blood related disorders was done by Bio-Rad D-10 instrument. 153 (35.7%) patients out of 428 had haemoglobinopathies. Thalassaemia minor (70 cases, 16.35 %), thalassaemia major (32 cases, 7.48%), sickle cell disease (22 cases, 5.14 %) and sickle cell trait (12 cases, 2.8%) were most common haemoglobinopathies. Less prevalent haemoglobinopathies were sickle-β-thalassaemia, α,βthalassaemia heterozygote, Hb D trait, Hb E trait, Hb Ethalassaemia, Hb D disease, Hb E disease and sickle D disease. Our study indicates that almost all the common haemoglobinopathies are prevalent in Gujarat but sickle cell trait/anemia and β thalassaemia are very common. Various haemoglobinopathies are major public health problem in Gujarat, a state located in the western part of India. The data pertaining to their occurrence and prevalence in the state of Gujarat are scarce and hence it was considered worthwhile to study the burden of haemoglobinopathies in Gujarat, India. A retrospective analysis of blood samples of 428 cases referred to the pathology laboratory from various private practitioners/Government hospitals for the workup of anemia or other blood related disorders was done by BioRad D-10 instrument. 153 (35.7%) patients out of 428 had haemoglobinopathies. Thalassaemia minor (70 cases, 16.35 %), thalassaemia major (32 cases, 7.48%), sickle cell disease (22 cases, 5.14 %) and sickle cell trait (12 cases, 2.8%) were most common haemoglobinopathies. Less prevalent haemoglobinopathies were sickle-?-thalassaemia, ?,?thalassaemia heterozygote, Hb D trait, Hb E trait, Hb Ethalassaemia, Hb D disease, Hb E disease and sickle D disease. Our study indicates that almost all the common haemoglobinopathies are prevalent in Gujarat but sickle cell trait/anemia and ? thalassaemia are very common.

Diagnosis of acute malaria by laser based cell counter with comparison of conventional and recent techniques in Indian scenario.

Abstract: Malaria is one of the most important parasitic diseases in humans affecting 103 countries worldwide. Aims: The present study aims to determine the diagnostic utility of cell counter data - hemoglobin, total leukocyte count, platelet count and depolarized laser light (DLL)-based purple-coded events (PCEs) in detection of acute malaria. This is a retrospective study of 523 patient data that came for complete blood count for the first time. Results : One hundred thirty-five of the 523 patients showed microscopic evidence of malaria. Platelet count showed the highest sensitivity of 77.77% (105/135). PCEs (≥1) showed 43.7% (59/135) sensitivity. Conclusions : It is concluded that a low platelet count (<150 × 109/L) is a good hematological parameter for presumptive diagnosis of malaria. If we change the cut-off for PCEs from ≥1 to ≥2, the sensitivity would be 56.29% (76/135) and the specificity would be 94.58% (367/388), respectively. The sensitivity of DLL was low, particularly with a low parasitic index (PI). The number of PCEs does not correlate with the PI. The cut-off number of PCEs in DLL-based malaria detection should be modified in highly endemic areas.

Hematological indices for differential diagnosis of Beta thalassemia trait and iron deficiency anemia.

Abstract: Background. The two most frequent types of microcytic anemia are beta thalassemia trait (β-TT) and iron deficiency anemia (IDA). We retrospectively evaluated the reliability of various indices for differential diagnosis of microcytosis and β-TT in the same patient groups. Methods. A total of 290 carefully selected children aged 1.1–16 years were evaluated. We calculated 12 discrimination indices in all patients with hemoglobin (Hb) values of 8.7–11.4 g/dL. None of the subjects had a combined case of IDA and β-TT. All children with IDA received oral iron for 16 weeks, and HbA2 screening was performed after iron therapy. The patient groups were evaluated according to red blood cell (RBC) count; red blood distribution width index; the Mentzer, Shine and Lal, England and Fraser, Srivastava and Bevington, Green and King, Ricerca, Sirdah, and Ehsani indices; mean density of hemoglobin/liter of blood; and mean cell density of hemoglobin. Results. The Mentzer index was the most reliable index, as it had the highest sensitivity (98.7%), specificity (82.3%), and Youden’s index (81%) for detecting β-TT; this was followed by the Ehsani index (94.8%, 73.5%, and 68.3%, resp.) and RBC count (94.8%, 70.5%, and 65.3%). Conclusion. The Mentzer index provided the highest reliabilities for differentiating β-TT from IDA.

Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia: a reply

Abstract: Background More than 40 mathematical indices have been proposed in the hematological literature for discriminating between iron deficiency anemia and thalassemia trait in subjects with microcytic red blood cells (RBCs). None of these discriminant indices is 100% sensitive and specific and also the ranking of the discriminant indices is not consistent. Therefore, we decided to conduct the first meta-analysis of the most frequently used discriminant indices. Methods An extensive literature search yielded 99 articles dealing with 12 indices that were investigated five or more times. For each discriminant index we calculated the diagnostic odds ratio (DOR) and summary ROC analysis was done for comparing the performance of the indices. Results The ratio of microcytic to hypochromic RBCs (M/H ratio) showed the best performance, DOR=100.8. This was significantly higher than that of all other indices investigated. The RBC index scored second (DOR=47.0), closely followed by the Sirdah index (DOR=46.7) and the Ehsani index (DOR=44.7). Subsequently, there was a group of four indices with intermediate and three with lower DOR. The lowest performance (DOR=6.8) was found for the RDW (Bessman index). Overall, the indices performed better for adults than for children. Conclusions The M/H ratio outperformed all other discriminant indices for discriminating between iron deficiency anemia and thalassemia trait. Although its sensitivity and specificity are not high enough for making a definitive diagnosis, it is certainly of value for identifying those subjects with microcytic RBC in whom diagnostic tests for confirming thalassemia are indicated.

The role of automated measurement of RBC subpopulations in differential diagnosis of microcytic anemia and β-thalassemia screening.

Abstract: Cell counter–based formulas have been used in the differential diagnosis of microcytic anemia. The measurement of RBC subpopulations is now available on the Sysmex XE 5000 analyzer (Sysmex, Kobe, Japan). We describe the new formulas: % microcytic – % hypochromic; and % microcytic – % hypochromic – red cell distribution width (RDW), derived from the percentages of microcytic and hypochromic RBCs. The present study aimed to prospectively evaluate the reliability of these new formulas in the differential diagnosis of microcytosis and β-thalassemia screening compared with already published indices. The indices were calculated for a set of 250 iron-deficient patients and 270 β-thalassemia carriers. Independent samples t test and receiver-operating characteristics analysis were applied. The % microcytic – % hypochromic – RDW, % microcytic – % hypochromic, and Green and King indices provided higher areas under the curve. The % microcytic – % hypochromic – RDW was the most reliable index evaluated, with 100% sensitivity and 92.6% specificity. This index can be used to efficiently screen patients with microcytosis for further hematologic studies to confirm β-thalassemia.

Automated haematology analysis to diagnose malaria

Abstract: For more than a decade, flow cytometry-based automated haematology analysers have been studied for malaria diagnosis. Although current haematology analysers are not specifically designed to detect malaria-related abnormalities, most studies have found sensitivities that comply with WHO malaria-diagnostic guidelines, i.e. ≥ 95% in samples with > 100 parasites/μl. Establishing a correct and early malaria diagnosis is a prerequisite for an adequate treatment and to minimizing adverse outcomes. Expert light microscopy remains the 'gold standard' for malaria diagnosis in most clinical settings. However, it requires an explicit request from clinicians and has variable accuracy. Malaria diagnosis with flow cytometry-based haematology analysers could become an important adjuvant diagnostic tool in the routine laboratory work-up of febrile patients in or returning from malaria-endemic regions. Haematology analysers so far studied for malaria diagnosis are the Cell-Dyn®, Coulter® GEN·S and LH 750, and the Sysmex XE-2100® analysers. For Cell-Dyn analysers, abnormal depolarization events mainly in the lobularity/granularity and other scatter-plots, and various reticulocyte abnormalities have shown overall sensitivities and specificities of 49% to 97% and 61% to 100%, respectively. For the Coulter analysers, a 'malaria factor' using the monocyte and lymphocyte size standard deviations obtained by impedance detection has shown overall sensitivities and specificities of 82% to 98% and 72% to 94%, respectively. For the XE-2100, abnormal patterns in the DIFF, WBC/BASO, and RET-EXT scatter-plots, and pseudoeosinophilia and other abnormal haematological variables have been described, and multivariate diagnostic models have been designed with overall sensitivities and specificities of 86% to 97% and 81% to 98%, respectively. The accuracy for malaria diagnosis may vary according to species, parasite load, immunity and clinical context where the method is applied. Future developments in new haematology analysers such as considerably simplified, robust and inexpensive devices for malaria detection fitted with an automatically generated alert could improve the detection capacity of these instruments and potentially expand their clinical utility in malaria diagnosis.

Discriminant value of % microcytic/% hypochromic ratio in the differential diagnosis of microcytic anemia.

Abstract: Background: % Microcytic and % hypochromic red cells show an inverse trend in b thalassemia trait and in iron deficiency anemia (IDA). The aim of this study was to assess the discriminant value of % microcytic/ % hypochromic ratio, as can be obtained from the Advia 2120 (Siemens) analyzer, in the differential diagnosis of microcytic anemia, compared to the conventional England and Fraser, Green and King, Mentzer, Ricerca, Shine and Lal and Srivastava indices. Methods: Receiver operating characteristic (ROC) curves, sensitivity, specificity and Youden index of indices were calculated for a set of 148 IDA patients and 170 b thalassemia carriers. Results: The Green and King index showed the best area under the curve (AUC, 0.962), with a Youden index of 80.9%; the % microcytic/% hypochromic ratio ranked second (AUC 0.943), with a Youden index of 76.3% and a sensitivity of 99.2%. Conclusions: This index, with high sensitivity for b thalassemia screening, can be a useful tool in the differential diagnosis of microcytic anemia, so samples can be chosen for HbA2 analysis, to confirm the presumptive diagnosis of the disease. As specificity is 77.1%, we assume it will be 22.9% for false positives, but these samples will have HbA2 values within the reference range, for correct diagnosis. Clin Chem Lab Med 2008;46:1752–8.