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Introduction Laboratory diagnosis of hereditary spherocytosis ( HS) relies on increased incubated red cell osmotic fragility test for screening. We evaluated the diagnostic role of eosin-5′-maleimide ( EMA) binding test by flow cytometry in spherocytic and microcytic hypochromic hematological disorders in North Indians. Methods EMA binding test using flow cytometry was performed on 55 HS (40 families), 26 iron deficiency anemia ( IDA), 32 β-thalassemia trait (β TT), and 10 autoimmune hemolytic anemia ( AIHA) cases and 121 normals. Mean channel fluorescence ( MCF) and coefficient of variation ( CV) were studied. Different MCF parameters ( MCF, MCF ratio, percent decrease MCF) and percent increase in CV were analyzed. Receiver operating characteristics analysis was performed to determine best cutoff values, sensitivity, and specificity for discriminating HS from other red cell disorders. Results MCF ratio of HS group was significantly lower than normals (0.67 ± 0.07 vs. 1.01 ± 0.05, P < 0.001) and other cases. All patients with HS showed MCF ratio to be ≤0.79. Four postsplenectomy cases with near-normal hemograms also revealed low MCF ratio, showing the specificity of the test. Conclusions EMA assay was efficient to diagnose cases of HS including postsplenectomy cases and shows no overlap with IDA, β TT, and AIHA. [ABSTRACT FROM AUTHOR]

Introduction The potential impact of concomitant iron deficiency on hemoglobin A2 (HbA2)-based identification of β-thalassemia trait (β TT) is a worrisome issue for screening laboratories. This is especially true for resource-constrained settings where iron deficiency is widespread and molecular confirmatory tests for borderline low HbA2 values may be unavailable. Methods Obligate β TT carrier individuals ( n = 752) were identified during screening studies on the parents of thalassemia major patients. HbA2%, complete blood counts and serum iron, ferritin and transferrin saturation were studied. Iron-deficient individuals ( n = 135) with normal range HbA2% were taken as controls. Results Concomitant iron deficiency (defined as ferritin ≤15 ng/mL and/or transferrin saturation ≤15%) was present in 20.7% (156/752) βTT cases, that is, 33.3% females (122/366) and 8.8% males with βTT (34/386). Mean HbA2 in iron-replete βTT was 5.4 ± 0.8 (range 3.1-7.9) and in iron-deficient βTT was 5.4 ± 0.9 (range 3.3-7.6). HbA2 < 4.0% was found in 23/752 (3.1%) βTT: 13/595 iron-replete (2.2%) and 10/157 (6.4%) iron-deficient βTT individuals. However, five of the 10 iron-deficient βTT cases carried the silent CAP+1 (A>C) β-thalassemia allele accounting for the borderline HbA2%. On a separate analysis, all five severely anemic βTT (Hb < 80 g/L) and 16/17 βTT with severe hypoferritinemia (<5 ng/mL) had HbA2 > 4.5%. The single case with serum ferritin 4.8 ng/mL and HbA2 3.3% showed a CAP+1 (A>C) mutation. Conclusions Iron deficiency was prevalent among north Indian β TT individuals, especially women. After adjusting for other causes of low HbA2 in β TT, iron deficiency, even when very severe, was very unlikely to interfere significantly with HbA2-based identification of β TT. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article regarding elevated mean neutrophil volume+CRP is a highly sensitive and specific predictor of neonatal sepsis.

A letter to the editor is presented in response to the article "Inappropriate Use of Protein C, Protein S, and Antithrombin Testing for Hereditary Thrombophilia Screening: an Experience from a Large University Hospital," by Tientadakul and colleagues in the December 2011 issue.