A Framework for Anemia Differential Diagnosis in Paleopathology Incorporating Metric Methods

Area of Science:

• Paleopathology
• Bioarchaeology
• Forensic Anthropology

Background:

• Anemia diagnosis in historical populations often relies on macroscopic skeletal lesions.
• Micro-CT imaging offers a novel approach to assess sub-macroscopic indicators of anemia.

Purpose of the Study:

• To explore metric manifestations of anemia in growing crania using micro-CT.
• To propose a diagnostic framework for inferring anemia based on skeletal parameters.

Main Methods:

• Micro-CT analysis of 68 orbits/frontal bones from 18th-19th century archaeological collections (birth to 15 years).
• Visual assessment for marrow hyperplasia and calculation of bone microarchitecture T-scores.
• Measurement of frontal bone cortical thickness ratios.

Main Results:

• Anemia was inferred in 16% of the analyzed sample.
• Trabecular separation T-scores proved most significant for anemia evaluation.
• Frontal bone ratios were less informative; age significantly impacted bone measurements.

Conclusions:

• A diagnostic framework combining metric features and internal visual criteria aids anemia assessment.
• This approach provides clearer evidence of anemia-related bone changes than macroscopic evaluation alone.
• Prioritizing metric features linked to the etiology of marrow hyperplasia enhances diagnostic accuracy.