Early Detection Of Thalassemia Carrier In Patients With SystemicLupus Erythematous: The Use of Shine and Lal Index

Abstract

Background: Anemia in systemic lupus erythematous (SLE) is common due to
impaired erythropoietin response and the presence of antibodies that attack
erythropoietin. Various anemia in SLE include autoimmune hemolytic anemia (AIHA),
anemia of chronic disease (ACD), or iron deficiency anemia (IDA). Interestingly,
Indonesia lies in thalassemia belt area and it is estimated to harboring around 6-10%
thalassemia carrier in its population. Therefore, anemia in SLE patients should be
further examined for its possibility for thalassemia carrier. This study aimed to
determine whether a simple erythrocyte index could be used for thalassemia carrier
early detection of SLE patients living in Indonesia. Methods: This study had a
retrospective and cross-sectional design, collecting hematology data of SLE patients
registered at Dr. Hasan Sadikin General Hospital. Erythrocyte indices, including
Mentzer index (MCV/RBC) and Shine & Lal index (MCV.MCH.MCH/100), were
assessed to determine IDA or thalassemia carrier. Results: Of 259 hematology data
from SLE patients included, predominantly female (95.8%), aged 34 years old (median;
range 17-65 years) and single (27%), of whom 45.2% had anemia. However, most of
them were anemia normocytic or normochromic. Interestingly, Mentzer index (<13) was
found in 2.7% and Shine & Lal index (<1530) in 10% patients, suggesting consider
thalassemia carrier. Conclusion: Although Shine & Lal index has lower sensitivity
compared with Mentzer index, Shine & Lal Index might serve a broader screening tool
as an early detection for thalassemia carrier.