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Related Experiment Video

Updated: Aug 27, 2025

Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management

Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management

Published on: January 19, 2024

The alternative Thomas-plot: A new tool for effective anemia diagnostics.

Kitty de Leur¹, Nadine M C Pouw¹, Jordy Lopez¹

¹Klinisch Chemisch Laboratorium en Trombosedienst, Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands.

International Journal of Laboratory Hematology

|September 28, 2022

Summary

An alternative Thomas-plot using transferrin (Tf)/log ferritin ratio effectively diagnoses anemia types. This method improves iron status assessment in anemic patients and simplifies implementation compared to the traditional soluble transferrin receptor (sTfR) plot.

Keywords:

Ret-He anemia anemia of chronic disease iron deficiency thomas-plot

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Area of Science:

Hematology
Clinical Diagnostics

Background:

The Thomas-plot aids in differentiating anemia types by combining reticulocyte hemoglobin content (Ret-He) with the soluble transferrin receptor (sTfR)/log ferritin (fer) ratio.
Current laboratory diagnostics for anemia can be complex and may leave cases of unknown etiology (ECI).

Purpose of the Study:

To develop and validate an alternative Thomas-plot using the transferrin (Tf)/log ferritin ratio.
To compare the diagnostic performance of the alternative Thomas-plot against the classical Thomas-plot and existing anemia diagnostics.

Main Methods:

A total of 536 anemic patients were analyzed.
Receiver Operating Characteristic (ROC) curves were generated using the first 188 patients to establish optimal cut-off values for both Thomas-plots.
The performance of both plots was evaluated in the subsequent 348 patients against current anemia diagnostic methods.

Main Results:

Optimal cut-off values were determined: Ret-He at 31.2 pg, sTfR/log(fer) at 0.91, and Tf/log(fer) at 1.71.
Both Thomas-plots reduced the proportion of ECI cases from 39% to 27%.
The alternative plot facilitated a more detailed analysis of iron status in anemia of chronic disease (ACD) and distinguished between latent and classical iron deficiencies, observing a shift from classical iron deficiency anemia (IDA) to functional IDA.

Conclusions:

The alternative Thomas-plot is an effective diagnostic tool, offering a more in-depth view of anemic patients' iron status.
Its implementation is simpler due to the use of transferrin (Tf) instead of the soluble transferrin receptor (sTfR).