"[
ABSTRAKAnemia defisiensi besi dan thalassemia β trait merupakan penyebab
tersering anemia mikrositik hipokrom di Indonesia. Kedua penyakit tersebut sulit
dibedakan hanya dengan pemeriksaan hematologi, oleh karena itu diperlukan
pemeriksaan tambahan seperti feritin dan analisis hemoglobin. Namun tidak semua
laboratorium dapat melakukan pemeriksaan ini. Banyak penelitian yang
membedakan kedua penyakit tersebut dengan indeks eritrosit. Namun indeks
eritrosit memiliki nilai diagnostik yang berbeda di setiap negara dan belum ada data
di Indonesia. Penelitian ini melakukan uji diagnostik Indeks Mentzer, RDW, Green-
King, Sirdah, dan mencari nilai cut-off baru yang memberikan nilai diagnostik lebih
baik.
Penelitian terdiri dari 98 subyek definitif anemia defisiensi besi dan 80
subyek thalassemia β trait. Nilai diagnostik Indeks Mentzer untuk anemia defisiensi
besi adalah sensitivitas 83.6%, spesifisitas 66.2%, NPP 75.2%, NPN 76.8%, RKP
2.4, RKN 0.2. Nilai diagnostik Indeks Mentzer untuk thalassemia β trait adalah
sensitivitas 66.2%, spesifisitas 83.6%, NPP 76.8%, NPN 75.2%, RKP 4.0, RKN
0.4. Nilai diagnostik Indeks RDW untuk anemia defisiensi besi adalah sensitivitas
91.8%, spesifisitas 75%, NPP 81.8%, NPN 88.2%, RKP 3.6, RKN 0.1. Nilai
diagnostik Indeks RDW untuk thalassemia β trait adalah sensitivitas 75%,
spesifisitas 91.8%, NPP 88.2%, NPN 81.8%, RKP 9.1, RKN 0.2. Nilai diagnostik
Indeks Green-King untuk anemia defisiensi besi adalah sensitivitas 96.9%,
spesifisitas 67.5%, NPP 78.5%, NPN 94.7%, RKP 2.9, RKN 0.04. Nilai diagnostik
Indeks Green-King untuk thalassemia β trait adalah sensitivitas 67.5%, spesifisitas
96.9%, NPP 94.7%, NPN 78.5%, RKP 22.0, RKN 0.3. Nilai diagnostik Indeks
Sirdah untuk anemia defisiensi besi adalah sensitivitas 92.8%, spesifisitas 58.7%,
NPP 73.3%, NPN 87.0%, RKP 2.2, RKN 0.1.Nilai diagnostik Indeks Sirdah untuk
thalassemia β trait adalah sensitivitas 58.7%, spesifisitas 92.8%, NPP 87.0%, NPN
73.3%, RKP 8.2, RKN 0.4. Nilai cut-off baru Indeks Mentzer adalah 13.44, RDWI
233.4, Green-King 75.06, dan Sirdah 32.52.
Keempat indeks eritrosit dapat diaplikasikan untuk orang Indonesia dengan
Indeks Green-King sebagai indeks yang terbaik.
ABSTRACTIron deficiency anemia and β trait thalassemia are the most common causes
of microcytic hypochromic anemia in Indonesia. Differentiation between them is
difficult when solely based on a hematology examination, so additional laboratory
tests are required such as ferritin and hemoglobin analysis. However, not all
laboratories can perform these tests. Many erythrocytes indices have been proposed
to determine whether a blood sample is more suggestive for iron deficiency anemia
or β trait thalassemia. Unfortunately these indices have different diagnostic value
in many countries and there is no data about diagnostic value in Indonesia. This
study performs diagnostic test Mentzer, RDW, Green-King, and Sirdah Index and
develops a new cut-off point that could make a better diagnostic value.
This study consists of 98 subjects of iron deficiency anemia and 80 subjects
of β trait thalassemia. Diagnostic values of Mentzer Index for iron deficiency
anemia were sensitivity 83.6%, specificity 66.2%, PPV 75.2%, NPV 76.8%, LR+
2.4, LR- 0.2. Diagnostic values of Mentzer Index for β trait thalassemia were
sensitivity 66.2%, specificity 83.6%, PPV 76.8%, NPV 75.2%, LR+ 4.0, LR- 0.4.
Diagnostic values of RDW Index for iron deficiency anemia were sensitivity
91.8%, specificity 75%, PPV 81.8%, NPV 88.2%, LR+ 3.6, LR- 0.1. Diagnostic
values of RDW Index for β trait thalassemia were sensitivity 75%, specificity
91.8%, PPV 88.2%, NPV 81.8%, LR+ 9.1, LR- 0.2. Diagnostic values of Green-
King Index for iron deficiency anemia were sensitivity 96.9%, specificity 67.5%,
PPV 78.5%, NPV 94.7%, LR+ 2.9, LR- 0.04. Diagnostic values of Green-King
Index for β trait thalassemia were sensitivity 67.5%, specificity 96.9%, PPV 94.7%,
NPV 78.5%, LR+ 22.0, LR- 0.3. Diagnostic values of Sirdah Index for iron
deficiency anemia were sensitivity 92.8%, specificity 58.7%, PPV 73.3%, NPV
87.0%, LR+ 2.2, LR- 0.1. Diagnostic values Sirdah Index for β trait thalassemia
were sensitivity 58.7%, specificity 92.8%, PPV 87.0%, NPV 73.3%, LR+ 8.2, LR-
0.4. The new cut-off point of Mentzer, RDW, Green-King, and Sirdah Index was
13.44, 233.4, 75.06, and 32.52 respectively.
All indices can be applied for Indonesian people, among which Green-King
Index had the best diagnostic value, Iron deficiency anemia and β trait thalassemia are the most common causes
of microcytic hypochromic anemia in Indonesia. Differentiation between them is
difficult when solely based on a hematology examination, so additional laboratory
tests are required such as ferritin and hemoglobin analysis. However, not all
laboratories can perform these tests. Many erythrocytes indices have been proposed
to determine whether a blood sample is more suggestive for iron deficiency anemia
or β trait thalassemia. Unfortunately these indices have different diagnostic value
in many countries and there is no data about diagnostic value in Indonesia. This
study performs diagnostic test Mentzer, RDW, Green-King, and Sirdah Index and
develops a new cut-off point that could make a better diagnostic value.
This study consists of 98 subjects of iron deficiency anemia and 80 subjects
of β trait thalassemia. Diagnostic values of Mentzer Index for iron deficiency
anemia were sensitivity 83.6%, specificity 66.2%, PPV 75.2%, NPV 76.8%, LR+
2.4, LR- 0.2. Diagnostic values of Mentzer Index for β trait thalassemia were
sensitivity 66.2%, specificity 83.6%, PPV 76.8%, NPV 75.2%, LR+ 4.0, LR- 0.4.
Diagnostic values of RDW Index for iron deficiency anemia were sensitivity
91.8%, specificity 75%, PPV 81.8%, NPV 88.2%, LR+ 3.6, LR- 0.1. Diagnostic
values of RDW Index for β trait thalassemia were sensitivity 75%, specificity
91.8%, PPV 88.2%, NPV 81.8%, LR+ 9.1, LR- 0.2. Diagnostic values of Green-
King Index for iron deficiency anemia were sensitivity 96.9%, specificity 67.5%,
PPV 78.5%, NPV 94.7%, LR+ 2.9, LR- 0.04. Diagnostic values of Green-King
Index for β trait thalassemia were sensitivity 67.5%, specificity 96.9%, PPV 94.7%,
NPV 78.5%, LR+ 22.0, LR- 0.3. Diagnostic values of Sirdah Index for iron
deficiency anemia were sensitivity 92.8%, specificity 58.7%, PPV 73.3%, NPV
87.0%, LR+ 2.2, LR- 0.1. Diagnostic values Sirdah Index for β trait thalassemia
were sensitivity 58.7%, specificity 92.8%, PPV 87.0%, NPV 73.3%, LR+ 8.2, LR-
0.4. The new cut-off point of Mentzer, RDW, Green-King, and Sirdah Index was
13.44, 233.4, 75.06, and 32.52 respectively.
All indices can be applied for Indonesian people, among which Green-King
Index had the best diagnostic value]"
