Iron deficiency anemia and β thalassemia traits are most common causes of microcytic hypochromic anemias in India and poses a major health problem [1, 2]. The total expenditure on the management of hemoglobinopathies throughout the country is enormously high [3].

Carriers of haemoglobin disorders in the world are estimated to be 269 million. About 3% of word population carry β thalassemia gene. It is estimated that 50% of world s population with β thalassemia trait are in South east Asia [3]. Study of Kandhro et al determined ethnic-wise distribution of thalassemia trait in Sindh region of Pakistan, higher numbers of α- and β-thalassemia trait cases were seen in the Sindhi ethnic group [375 (64.21%) and 283 (69.02%), respectively] than in the other ethnic groups. In addition, a higher

distribution of β-thal trait cases was observed in the Sindhi ethnic group [n = 327 (56%)] in α- and β-thalassemia cases overall [4]. Screening of anemias in sindhi community is essential as disease burden is high in this community. Mass awareness and proper counseling of positive cases plays a important role in prevention of inheritance of hemoglobinopathies [5].

A definitive diagnosis between β thalassemia trait and iron deficiency anemia is based on HbA2 and serum ferritin levels [6]. But HbA2 and serum ferritin levels are costly investigations and are not available in small set up. So there should be methods which will screen and differentiate individuals for β thalassemia trait and iron deficiency anemia at lower cost. Red blood indices are routine investigation done for almost every disease and even at set up.

So red cell indices like RBC count, MCV, MCH and RDW can be helpful for differential diagnosis of iron deficiency anemia and β thalassemia and reduce unnecessary cost [7-9]. Long term objective of this study was screening of anemic individuals of Sindhi community for thalassemia trait and to reduce the disease burden and preventing the inheritance by proper counseling and awareness also at lower cost and even in small set ups.

Aims and Objectives

• To study red cell indices in microcytic hypochromic anemia.

Data analysis: Percentages were calculated for qualitative data. Means and standard deviation were calculated for quantitative data.

Unpaired t-test was used to compare means after looking at the distribution of variables for normality of data. P-value < 0.05 was considered significant throughout.

Ethical consideration & permission: An oral informed consent was taken from parents of children <18 years and individuals before including in the study. Study was approved by Institutional ethical committee of Medical College, Sagar (M.P.)

A total of 200 patients with microcytic hypochromic anemia were included in the study comprising of 80 males and 120 females of which 175 cases were of iron deficiency anemia (105 females and 70 males) and 25 cases were of β thalassemia trait (15 females and 10 males). In the present study age of patient varies from 5 to 35 years with maximum number of patients in age group of 15-30 years. Of 80 males,35% belongs to 5-14 years of age, 65% belongs to 15-35 years of age. Of 120 females,40% belongs to 5-14 years and 60% belongs to 15-35 years of age.

Table-1: Distribution of HbA2 levels in β Thalassemia trait and Iron deficiency anemia patients.

Table-2: Distribution of serum ferritin level in βThalassemia trait and Iron deficiency anemia patients.

Hemoglobinopathy is a hematological disorder occurring due to the modification in the genetically determined molecular structure of hemoglobin. India has an extreme diverse population of 1.30 billion. It comprises numerous castes, sub castes, and tribal groups in different geographic regions. Due to large scale migration of population of Sindhi community during partition of India in 1947, the prevalence of hemoglobinopathy in Sindhi community is quite variable.

In India, on an average estimate 8000-1000 children are born every year with thalassemia major disease [10]. Several studies in the literature have reported that Sindhi community has high frequency of thalassemia along with similarity in clinical features of iron deficiency and traits of β thalassemia [7, 11]. In the present study, traits of β thalasemia and iron deficiency anemia cases were confirmed by HbA2 levels and serum ferritin levels with the study of red cell indices MCV, MCH, RBC count and RDW.

The evaluation of the reliability of different RBC indices in Pelestinian population was studied by Sirdan et al [12] and it was concluded that these indices had highest accuracy in differentiation between β thalassemia trait and iron deficiency anemia. In the areas of high prevalence of β thalassemia, the utilization of cell counter based parameters for the detection of β thalassemia was studied by Rathod et al [9]. In the present study, the mean MCV (63.5±1.6) and MCH (19.2±0.6) in β thalassemia cases were lower than those found in iron deficiency anemia cases i.e. (65.2±5.3) and (20.1±0.8) respectively with significant p value of <0.0001.

The mean RDW values were increased in both the groups but the iron deficiency anemia group showed the higher values i.e. (19.53±3.00) as compared to the β thalassemia group (15.8±0.91) with significant p value of <0.0001. The mean RBC count in β thalassemia group were higher i.e. (5.81±0.34) in males in comparison to the iron deficiency group i.e. (4.29±0.49) with significant p value of <0.0001. The observations recorded in the present study were comparable to the outcomes obtained from the studies of Jaswani et al^.[13], Soliman et al [14] and Bhushan et al [15]. Other Indian author found similar observation [14, 15].

A significant difference can be observed in the