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Research Article






Rukwal Sonica, Kaur Harpreet

Abstract: Background and Aim: Mentzer index can differentiate microcytosis due to Thalassemia from other causes in a minimal resource setting and therefore, it can be playing a significant role in screening of Thalassemia in general population as well as distinguishing β Thalassemia trait from iron deficiency anemia has important clinical implications. The misdiagnosis of β Thalassemia trait has consequences for potential homozygous offspring leading to β Thalassemia disease. We aim to evaluate the diagnostic importance of Mentzer Index for screening Thalassemia minor as compared to other indices and differentiating it from other causes of microcytic anemia at our center. Materials and Methods: This is a retrospective analytical study done over a period of 2 years from 1, Jan 2021 to 30, Dec 2022. In this study, a retrospective analysis of all the patients whose High-Performance Liquid Chromatography (HPLC) was performed at our laboratory and had microcytic hypochromic RBC picture, was done. Mentzer Index of all these patients was calculated and the results were analyzed and further compared with HPLC. The cut off for Mentzer Index was taken as 13. Results: Total patients screened during the study were 176, out of which 54 patients were Thalassemia minor diagnosed through HPLC. Sensitivity of Mentzer index to detect thalassemic patient was 79.4%, specificity 95.3%, positive predictive value 90% and negative predictive value was found to be 89.7%. Sensitivity of Mentzer index is higher when compared to other indices in our study. Conclusion: Mentzer Index can be calculated from Complete blood counts with red blood cell indices can be used to target population who should be screened for Thalassemia even in a resource poor setting. Various studies and now ours proves Mentzer index to be a good and cheaper alternative to screen patients at primary health centers and can help to reduce the burden of Thalassemia major in society.

KEYWORDS: Mentzer Index, Thalassemia, High-Performance Liquid Chromatography, microcytosis


  1. [1]. Sherali A, Ahad A, Tikmani SS, Sohail S. Screening of Iron Deficiency Anemia in Children Using Mentzer Index in Pakistan: A Cross Sectional Study. Global Pediatric Health. 2023; 10.   

  2. [2]. Bouri S, Martin J. Investigation of iron deficiency anaemia Clin Med (Lond). 2018; 18,3:242-244.

  3. [5]. Tabassum S, Khakwani M, Fayyaz A, Taj N. Role of Mentzer index for differentiating iron deficiency anemia and beta thalassemia trait in pregnant women. Pak J Med Sci. 2022; 38 (4Part-II):878-882.

  4. [6]. Dacie, J.V. and Lewis, S.M. (2001) Practical Haematology. In: Lewis, S.M., Bain, B.J. and Bates, I. Eds., Practical Heamatology, 12th Edition, Churchill Livingstone, Harcourt Publishers Limited, London. Chapter 14; pages 302-330

  5. [7]. Thomas C, Thomas L. Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Clin Chem. 2002 Jul; 48,7:1066-76.

  6. [8]. Shivashankara A.R, Jailkhani R, Kini A. Hemoglobinopathies in Dharwad, North Karnataka: A Hospital-Based Study. Journal of Clinical and Diagnostic Research [serial online] 2008; 2:593-599.   

  7. [9].  Shalev O,Yehezke lE, Rachmilewitz EA. Inadequate utilization of routine electronic RBC counts to identify beta Thalassemia carriers. Am J Public Health. 1993; 78:1476-1477  

  8. [10]. G Ajeet. Mentzer Index for Differential Diagnosis of Iron Deficiency anaemia and
    Beta Thalassemia Trait JMSCR Volume 04 Issue 12 December 2016 Pages 15138-15142       

  9. [11]. A Sufia, Z Noorin, R M Syed, I Sumaiya, A Sharique Indices in differentiating iron deficiency anemia from Thalassemia trait-a comparative study. Asian Journal of Medical Sciences | Oct 2021 | Vol 12 | Issue 10, Pages 81-86.  

  10. [12]. Rathod DA, Kaur A, Patel V, Patel K, Kabrawala R, Patel V, Patel M, Shah P. Usefulness of cell counter-based parameters and formulas in detection of β-Thalassemia trait in areas of high prevalence.Am J Clin Pathol. 2007; 128(4)585-589.

  11. [13]. Thiyagarajan A, Bhattacharya S, Sharma N, Srivastava A, Dhar DK. Need for a universal Thalassemia screening programme in India? A public health perspective. J Family Med Prim Care. 2019; 8,5:1528-1532.

  12. [14]. Z Majida, T Arfa, A C Quratulain , B M Syeda. Role of Red Cell Distribution Width and Mentzer Index in Differentiating Iron Deficiency Anemia from Anemia Due to β Thalassemia Trait. J South Asian Feder Obst Gynae 2019;11,5:297–300


  14. [15]. Urrechaga E, Borque L, Escanero JF. The role of automated measurement of RBC subpopulations in differential diagnosis of microcytic anemia and β-thalassemia screening. Am J Clin Pathol. 2011 ;135,3:374-9. 

  15. [16]. V aysel, O Gamze,D DAyşegul, U Selcuk, A N Mustafa, T Serdar and K Arzu,"Hematological Indices for Differential Diagnosis of Beta Thalassemia Trait and Iron Deficiency Anemia", Anemia, vol. 2014, Article ID 576738, 7 pages, 2014.

  16. [17]. I. Shine and S. Lal, “A strategy to detect β thalassaemia minor,” The Lancet, vol. 1, no. 8013, pp. 692–694, 1977.

  17. [18]. J. M. England and P. M. Fraser, “Differentiation of iron deficiency from thalassaemia trait by routine blood-count,” The Lancet, vol. 1, no. 7801, pp. 449–452, 1973.

  18. [19]. P. C. Srivastava, “Differentiation of thalassemia minor from iron deficiency,” The Lancet, 1973; vol. 2, pp. 154–155,

  19. [20]. R. Green and R. King, “A new red cell discriminant incorporating volume dispersion for differentiating iron deficiency anemia from thalassemia minor,” Blood Cells, 1989; vol. 15, no. 3, pp. 481–495.

  20. [21]. B. M. Ricerca, S. Storti, G. d'Onofrio et al., “Differentiation of iron deficiency from thalassaemia trait: a new approach,” Haematologica, 1987; vol. 72, no. 5, pp. 409–413.

  21. [22]. M. Sirdah, I. Tarazi, E. Al Najjar, and R. Al Haddad, “Evaluation of the diagnostic reliability of different RBC indices and formulas in the differentiation of the β-thalassaemia minor from iron deficiency in Palestinian population, ” International Journal of Laboratory Hematology, 2008;vol. 30, no. 4: pp. 324–330.

  22. [23].  M. A. Ehsani, E. Shahgholi, M. S. Rahiminejad, F. Seighali, and A. Rashidi, “A new index for discrimination between iron deficiency anemia and beta-thalassemia minor: results in 284 patients,” Pakistan Journal of Biological Sciences, 2009; vol. 12, no. 5, pp. 473–475.

  23. [24]. Lafferty JD, Crowther MA, Ali MA, Levine M. The evaluation of various mathematical RBC indicesandtheirefficacy in discriminating between thalassemic and non-thalassemic microcytosis. Am J ClinicPathol. 1996; 106,2, 201-205.

  24. [25]. Amer J. A Retrospective Study Using Mentzer Index for Prevalence of Iron Deficiency Anemia among Infants Visiting Maternal Centers at the Age of One Year. Anemia. 2022; 2022:7236317. 

  25. [26]. G Ajeet. Mentzer Index for Differential Diagnosis of Iron Deficiency anaemia and
    Beta Thalassemia Trait JMSCR Volume 04 Issue 12 December 2016 Pages 15138-15142

  26. [27]. Saxena S, Jain R Evaluation of the diagnostic reliability of Mentzer index for Beta Thalassemia trait followed by HPLC. Trop J PatholMicrobiol. 2020; 6,2:124-129.


  28. [28]. Sahli CA, Bibi A, Ouali F, Fredj SH, Dakhlaoui B, Othmani R, Laaouini N, Jouini L, Ouenniche F, Siala H, Touhami I, Becher M, Fattoum S, El Houda Toumi N, Messaoud T. Red cell indices: differentiation between β-thalassemia trait and iron deficiency anemia and application to sickle cell disease and sickle cell thalassemia. Clin Chem Lab Med. 2013; 51,8:1595-603.

  29. [29]. Hoffmann, Johannes J.M.L., Urrechaga, Eloísa and Aguirre, Urko. "Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia: a meta-analysis" Clinical Chemistry and Laboratory Medicine (CCLM), vol. 53, no. 12, 2015, pp. 1883-1894. 

  30. [30]. G Amita, S Manisha, S Divya, G Anil, N Seema. Dr Amita Gupta, Dr Manisha Shrivastava, Dr Divya Srivastava,Dr Anil Gupta, Dr Seema Navaid Mentzer Index as a screening tool for differential diagnosis of Iron Deficiency Anaemia and Beta Thalassemia Trait. European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11217-11223

  31. [31]. Claude Burdick, MD, Combined Iron Deficiency and Thalassemia Minor, American Journal of Clinical Pathology, Volume 139, Issue 2, February 2013, Page 260, 

  32. [32]. Verma S, Gupta R, Kudesia M, Mathur A, Krishan G, Singh S. Coexisting iron deficiency anemia and Beta thalassemia trait: effect of iron therapy on red cell parameters and hemoglobin subtypes. ISRN Hematol. 2014; 2014:293216.

  33. [33]. Massey AC. Microcytic anemia. Differential diagnosis and management of iron deficiency anemia. Med Clin North Am. 1992; 76,3:549-66.

 To cite this article:

Rukwal S, Kaur H. Evaluation of the diagnostic importance of Mentzer index for screening thalassemia minor and differentiating it from iron deficiency. Int. J. Med. Lab. Res. 2023; 8,2:35-42.

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