Usefulness of red blood cell flags in diagnosing and differentiating thalassemia trait from iron-deficiency anemia

Thalassemia trait (THA) is an important differential diagnosis of iron deficiency anemia (IDA). The red cell distribution width (RDW) is usually elevated in IDA, but often is normal in THA.

This study was conducted to determine the usefulness of red cell flags in differentiating iron deficiency anemia and thalassemia trait.

Peripheral blood samples from 50 patients suffering iron deficiency anemia and 64 patients suffering thalassemia trait were used to determine red cell flags (RCF) along with complete blood count, red cell distribution width, serum iron and total iron binding capacity, ferritin and hemoglobin electrophoresis. According to the data collected in this study, the first digit of red cell flags (RCF1)=0 was almost three times higher in thalassemic patients compared to those of iron deficiency anemia. Another reverse significant difference was observed in RCF1=2 (6.3% versus 42% for thalassemia and iron deficiency anemia respectively).

We conclude that RCF findings are sensitive and specific enough to be used as an approach in differentiating iron deficiency anemia from beta-thalassemia trait.