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Utilization of a new index to distinguish heterozygous thalassemic syndromes: comparison of its specificity to five other discriminants.

In 1984, a new index (the Makris index) combining erythrocytic and platelet parameters was described for the discrimination of the heterozygous thalassemic syndromes (beta and alpha). The algorithm is [(MCV/RDW)/(MPV/PDW)] divided by the RBC count in millions and requires for input the MCV, RDW, MPV, PDW, and RBC. The critical value used for separating the heterozygous thalassemic subjects is 1.84, which is the mean value plus 2 SD of our heterozygous subjects (confidence limit 95%). Because this index utilizes a confidence limit that includes 95% of affected persons, all individuals with values smaller than this need further investigation. It should be noted that the specificity of the index can be increased using the mean value of our heterozygous group plus 3 SD (X + 3 SD = 1.30 + 3*0.27 = 2.11, confidence limit 99%). In a series of 1510 "normal" subjects examined, 154 were designated as abnormals. None of the rest had abnormalities of cellular morphology or red cells osmotic resistance. The algorithm is readily incorporated into the software of an automated, whole blood analyzer. Using an expert system, we compared the sensitivity and specificity of the Makris index to five other discriminants (Mentzer, Shine et al., England et al., Green, and Bessman et al.). The Makris index distinguished between heterozygotes and normals without misdiagnosis.