| Objective:To evaluate the clinical usefulness of low hemoglobin density(LHD)in diagnosing iron deficiency anemia and differential diagnosing with anemia of chronic disease(ACD)by detecting LHD and iron metabolism indices,and then to dynamic observe the change of LHD during the oral iron for the treatment of IDA,which offers a new reference for diagnosis and treatment in IDA.Methods:All the patients were from outpatient and inpatient of the first hospital of Jilin University.Patients were divided into group of IDA,group of ACD and control group.And then group of ACD were further divided into anemia of cancer and renal anemia.Detect the LHD,RBC,HGB,HCT,MCV,MCH and MCHC by automatic hematology analyzer,the SI,SF and TIBC by automatic biochemical analyzer,and the Tf by the special protein analyzer.Compare the differences of indices in different groups.Calculate the sensitivity,specificity and AUC of LHD and iron metabolism indices in IDA and ACD.Analysis the correlation of LHD and iron metabolism indices.Dynamic monitor the change of LHD after oral iron at the 1st week,1st month,2ed month and 3ed month.All the data were analyzed by SPSS 23.0.Results:1.LHD in different groups: LHD in IDA(77.4%±23.4%)was significantly higher than LHD in anemia of cancer group(3.9%±3.7%),renal anemia group(5.4%±4.9%)and control group(2.3%±1.6%).(P<0.05).There was no significant difference between tumor anemia group and renal anemia group and control group.2.ROC curve analysis of LHD and iron metabolism index in IDA diagnosis: When the cutoff value of LHD for IDA was 6.8%,the area under ROC curve(AUC)was 0.993,sensitivity was 100%,and specificity was 98.4%.And the AUC,sensitivity and specificity of TS,SI,Tf,SF and TIBC were respectively(0.992、100%、96.7%),(0.984、98%、91.8%),(0.953、95.9%、90.2%),(0.947、98%、91.8%),(0.863、78.6%、77.6%).ROC curve analysis of LHD in ACD diagnosis: The sensitivity and specificity of LHD in anemia cancer was 39.5% and 100%,and renal anemia was 57.5% and 78.7%.3.Correlation analysis of LHD and iron metabolism indices: LHD was positively correlated with TIBC(r=0.32,P=0.008).And LHD was negatively correlated with SI and TS(r values were-0.419,-0.599).There was no significant correlation between LHD and SF,TF.4.Correlation analysis of LHD and HGB: IDA group was further divided into mild IDA group(HGB: 90~110/120g/L),moderate IDA group(HGB:60~90g/L)and severe IDA group(HGB:30~60g/L).LHD was 56.0%±19.2%,84.8%±17.4% and 94.6%±9.5% in mild IDA group,moderate IDA group and severe IDA group.LHD increased with the decrease of HGB,the two were negatively correlated(r=-0.515,P=0.00).5.Changes of LHD in patients with anemia before and after treatment: LHD was 87.8%±12.8% in 22 IDA patients before oral iron therapy,1 week later reduced to 81.8%±21.5%,1 month later 67.1%±20.4%,2 months later 37.8%±20.1%,and 3 months later 14.2%±7.2%.The level of LHD was significantly lower than that before treatment first months after treatment,the difference was statistically significant.LHD returned to nearly normal level at third months after treatment.There was no significant difference in LHD between before and after symptomatic treatment in patients with renal anemia and anemia of cancer.Conclusion:1.LHD has high sensitivity and specificity in the diagnosis of iron deficiency anemia.And LHD was significantly increased only in the absence of iron deficiency anemia,but not in other types of anemia without iron deficiency.LHD can be used as a reference index for the diagnosis and differential diagnosis of iron deficiency anemia.2.LHD was negatively correlated with HGB,and increased with the decrease of HGB,which could reflect the severity of iron deficiency anemia.3.There is a certain correlation between LHD and iron metabolism index,continuous dynamic monitoring of LHD can effectively evaluate the change of IDA and the treatment effect of iron. |
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