Meta - Analysis Of Screening Programs For Thalassemia

Thalassemia was a genetic chronic hemolytic disorders of hemoglobin (Hb), and the moderate or severity of thalassemia could endanger the lives of patients. The reason of this disease was that the gene deletion or mutation of globin could hampered the synthetic peptide, thus resulted in the globin chain imbalance. At present, there was no radical cure for Thalassemia and the expensive treatment costs brought heavy economic burden to patients’ families and the society,so through prenatal screening to prevent the patients’ birth was an effective measure to control the Thalassemia. But the Mediterranean anemia screening program that different countries using is not the same, even if the same screening scheme selected indicators threshold also have different. Therefore, system evaluation and analysis on the different screening program became an important problem of clinical decision makers should faced. In order to provide a more comprehensive and reliable understanding of clinical screening, it required a method to integrate the decentralized, local clinical screening results. Meta-analysis could magnify the clinical research of statistical effect and increases readability of results. According to literature retrieval, no Meta-analysis had been carried out to assess the screening of Thalassemia. To reflect the true clinical efficacy, this study will conducted a Meta-analysis to evaluate the clinical value of MCV in screening Thalassaemia.In meta-analysis, it needed to apply relevant knowledge of statistics. Heterogeneity test was an important part of the statistical analysis and the degree of heterogeneity usually adopt heterogeneity variance to measure.In order to ensure the reliability of the meta- analysis results, we analyze and compare different heterogeneity variance estimation method. Besides, we chose a high reliability and encapsulated in the commonly used methods of meta-analysis software. It provided scientific basis for screening the Mediterranean anemia by that using the red blood cell volume method for meta-analysis.By using R language and statistics related evaluation index,sample content and number of different levelswere simulated with six different kinds of heterogeneity variance estimation. The results were that restricted maximum likelihood function method had the highest efficiency. The second was maximum likelihood function method.sample content and number had a greater impact on heterogeneous variance approximate normal distribution. BT interval estimation could overestimate the statistical test of actual performance. Q statistic could underestimate the actual statistical test efficiency. SJ method had the largest gapwith the result of the evaluation index of ideal value.Therefore, when the Mediterranean anemia screening solutions was evaluated with the meta-analysis method, we used the restricted maximum likelihood function method which had the relative reliability.Meta-analysis results showed that the MCV screening of Mediterranean anemia pooled sensitivity was 93% (95% CI:92%-94%), and the pooled specificity was 76% (95% CI:75%--77%), which the missed diagnosis rate was 7% for patients with Mediterranean anemia, and the misdiagnosis rate was 24% for patients with un-Mediterranean anemia. In order to research the source of heterogeneity subgroup analyses, this paper demonstrated that the thalassemia type was the main source causing heterogeneity between studies.