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Clinical Chemistry 45: 1495-1500, 1999;
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(Clinical Chemistry. 1999;45:1495-1500.)
© 1999 American Association for Clinical Chemistry, Inc.

Articles

Predictive Value of Cord Blood Hematological Indices and Hemoglobin Barts for the Detection of Heterozygous {alpha}-Thalassemia-2 in an African-Caribbean Population

Fey P.L. van der Dijs1, Marcel Volmer2, Dieuwke G. van Gijssel-Wiersma2, Jan W. Smit3, Reind van Veen3 and Frits A.J. Muskiet2,a

1 Public Health Laboratory, Curaçao, The Netherlands Antilles.

2 Central Laboratory for Clinical Chemistry and
3 Central Laboratory for Hematology, Groningen University Hospital, 9700 RB Groningen, The Netherlands.
a Address correspondence to this author at: Central Laboratory for Clinical Chemistry, Room Y 1.147, Groningen University Hospital, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. Fax 31-50-3612290; e-mail f.a.j.muskiet{at}lab.azg.nl

Background: Cord blood hemoglobin Barts (HbBarts) and hemocytometric indices may be used for classification of newborns into those without {alpha}-thalassemia-2 ({alpha}{alpha}/{alpha}{alpha}) and with heterozygous {alpha}-thalassemia-2 (-{alpha}3.7/{alpha}{alpha}). We investigated by logistic regression analysis whether the combination of HbBarts and hemocytometric indices improves classification compared with classification based on a single analyte.

Methods: HbBarts percentages and hemocytometric indices were determined in cord blood of 208 consecutive newborns in Curaçao (Netherlands Antilles). Of these, 157 had {alpha}{alpha}/{alpha}{alpha} and 51 had -{alpha}3.7/{alpha}{alpha}, as established by DNA analysis.

Results: Between-group differences were significant for erythrocytes, mean cell volume, mean cell hemoglobin (MCH), mean cell hemoglobin concentration, platelets, hemoglobin F0 (HbF0), and HbBarts. The Logit equation of the logistic regression model, using MCH (pg) and HbBarts (%), was: 42.7164 + 5.7916(HbBarts) - 1.3110(MCH). A sensitivity of 100% was reached at a Logit value of -3.70. The corresponding specificity was 62.2%, and the predictive value of a positive test (PV+) was 46.3% (95% confidence interval, 37.0–55.7%). The relative information gains were as follows: 88% for the HbBarts-MCH combination, 26% for MCH (not significant), and 0% for HbBarts compared with the 24.6% -{alpha}3.7/{alpha}{alpha} prevalence.

Conclusion: Combined use of cord blood HbBarts and MCH improves classification compared with classification based on single hemocytometric indices.






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