Differential Diagnosis of Microcytic Anemia, Thalassemia or Iron Deficiency Anemia: A Diagnostic Test Accuracy Meta-Analysis

We evaluated the most common indices to compare their sensitivity and specificity to introduce the most sensitive and specific index. We systematically searched five international indexing databases up to Dec 2018. For each index, we measured the diagnostic odds ratio (DOR), as well as summary ROC (SROC) curve which was used to compare the performance of each index. Deeks̕ tests of all discriminant indices indicated that there is no potential publication bias. The area under curves (AUCs) of all discriminant indices indicate overall good differential performance. The M/H ratio index was more sensitive and specific compared to other studied indices. In this meta-analysis, the M/H ratio index was more potential to discriminate iron deficiency anemia (IDA) from thalassemia trait. However, we cannot use this index alone to achieve the final diagnosis. The capability of this index to discriminate IDA from thalassemia trait must be used alongside with the common laboratory procedure to ensure the final differentiation.