Evaluating the role of indirect bilirubin, urobilinogen and Shine & Lal index as an alternative screening tool for beta thalassemia minor

Ridham A. Khanderia, Amit H. Agravat

Abstract


Background: Beta thalassemia continues to be a significant burden to Western India particularly Saurashtra region of Gujarat. Since cost of treatment is high emphasis must be shifted from treatment to prevention that includes mass screening as most effective tool including RBC indices & peripheral blood smear. These tests have limited availability, re quire sophisticated equipments and are expensive. Thus, there is need for simple, low cost and reliable test which can be used in absence of sophisticated equipments. The present study has evaluated the validity of such test: indirect bilirubin and urine urobilinogen. Study had two objectives: 1) Estimation of indirect bilirubin, urobilinogen and Shine & Lal Index. 2) Comparing specificity and sensitivity of above test with HbA2 electrophoresis.

Methods: The present study was conducted on 100 (n=100) subjects in blood bank, department of pathology, government medical college Rajkot, Gujarat, India. In first group 50 subjects (Thalassemia minor) were selected while in second group 50 (n2=50) normal individuals from hospital staff were selected. Complete-haemogram, serum-direct, indirect and total bilirubin, urine urobilinogen and their sensitivity and specificity were calculated.

Results: Of the 50 cases in test group, 41 had higher Indirect Bilirubin level (>0.7 mg/dl), 35 had high urobilinogen level (>1 mg/dl). In control group out of 50 cases, 3 had high indirect bilirubin levels, 4 had high urobilinogen levels. Indirect-bilirubin had sensitivity of 82%, specificity of 94%. Urobilinogen showed sensitivity of 70% & specificity of 92%.

Conclusion: Indirect bilirubin and urine-urobilinogen is a valuable, cost-effective screening test for beta-thalassemia-trait with sensitivity & specificity comparable to RBC indices.

 


Keywords


Indirect-bilirubin, Screening test, Thalassemia, Urobilinogen

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References


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