| Obiective: Distinguish thalassemia and iron deficiency anemia through the blood routine examination, combination of splenomegaly, iron deficiency risk factors and the parents'blood routine examination to reduce the rate of missed diagnosis and misdiagnosis rate. of thalassemia.Methed: Review the 266 cases of thalassemia, 325 cases of iron deficiency anemia from January of 2000 to October of 2009 to summarize the clinical manifestations, the change of the red blood cell parameters in blood routine examination of the patients and some patients'parents to investigating the correlation and difference between two disease .Results:(1)In the group of thalassemia, male-to-female ratio is 1.31:1,the percent of patient among new born to 6 month is the most. In the group of iron deficiency anemia, male-to-female ratio is 2.69:1. sex ratio between two groups is significantly different. The percentage of patients from 6 to 24 month is the most.(2) there are many risk factors of iron deficiency In the group of IDA. For example , the percentage of feeding unreasonableness is 78.6%, the percentage of preterm birth or twins is 23.38%,the percent of low weightfatelis is 22.7%,only 11.1% of the patients have no special reason。(3) In the 325 cases of IDA ,68 cases are mild anemia ,159 cases are moderate anemia,97 cases are severity anemia . In the 266 cases of thalassemia ,68 cases are mild anemia,89 cases are moderate anemia,109 cases are severity anemia. The percentage of severity anemia in thalassemia is more than IDA,and have significant difference between two groups.(4)In the group of IDA,188 cases(66.2%) have hepatomegaly .In the group of THAL,166 cases (81.4%) have hepatomegaly. There is a significant difference between the two groups. In the group of IDA,66 cases(22.9%) have splenomegaly .In the group of THAL,144 cases (72%) have splenomegaly. There is a significant difference in the two groups.(5) In thalassemia group ,RBC decrease with anemia aggravated ,but MCV and MCH increase with anemia aggravated. In IDA group , the RBC dose not decrease significantly with anemia aggravated ,but the degree of microcellule hypochromic become more serious with anemia aggravated. (6)The MCV,MCH significantly decrease in THAL when anemia is mild.(7)The MCV/RBC is larger than 15 in the group of IDA. In the group of THAL, the MCV/RBC is smaller than 15 or close to 15 when anemia is mild, but MCV/RBC is larger than15 when anemia is moderate or severe.(8)The RDW-CV is higher than reference ranges in both IDA and thalassemia, and it rises with anemia aggravated. (9)The ratio of Ret increases with anemia aggravated. The ratio of Ret is higher in THAL than in IDA. (10)there is 77.1% parents'red cell appear microcellule hypochromic in thalassemia, but there is only 5.1% parents'red cell appear microcellule hypochromic in IDA.Conclusion:(1)Chongqing,Sichuan have a high morbidity of thalassemia , clinic symptom is easy to appear from new-born to 6 month, and the ratio of male to female is similar.(2)IDA is the common children disease in our country, the highest morbidity appears from 6 month to 24 month. In our result, male patients are more than female patients.(3) In thalassema group ,the RBC decrease with anemia aggravated ,while MCV increase.(4) In IDA group , the RBC dose not decrease significantly with anemia aggravated ,but MCV,MCH decrease with anemia aggravated. (5) The RDW-CV is hihger than reference ranges in IDA and thalassemia .The RDW-CV has no difference in IDA and thalassemia when anemia is mild, but it is significently higher in thalassemia when anemia is moderate or severe.(6) when microcellule hypochromic anemia is mild, we can screening IDA and thalassemia via MCV,MCH,MCV/RBC,RET. If MCV,MCH decrease siginificently , MCV/RBC is smaller than 15 and RET increase, it may be thalassemia, otherwise, it may be IDA. (7)when microcellule hypochromic anemia are moderate or severe, we can screening IDA and thalassamia through patients'blood routine combined with splenomegaly,jaundice,high risk of iron deficiency and parents'blood routine. |
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